Claims benefit specialist vs benefit specialist

The differences between claims benefit specialists and benefit specialists can be seen in a few details. Each job has different responsibilities and duties. It typically takes 4-6 years to become both a claims benefit specialist and a benefit specialist. Additionally, a benefit specialist has an average salary of $48,756, which is higher than the $47,292 average annual salary of a claims benefit specialist.

The top three skills for a claims benefit specialist include customer inquiries, appeals and medical terminology. The most important skills for a benefit specialist are customer service, HR, and patients.

Claims benefit specialist vs benefit specialist overview

	Claims Benefit Specialist	Benefit Specialist
Yearly salary	$47,292	$48,756
Hourly rate	$22.74	$23.44
Growth rate	-6%	7%
Number of jobs	32,208	31,663
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 59%
Average age	44	45
Years of experience	6	6

What does a claims benefit specialist do?

Claims and benefits specialists ensure their company's compliance with the internal and external health plan partner processes. The job requires them to be sharp, organized, and able to multitask. They recommend strategies that will improve the processes present in the current trends that they constantly evaluate. These specialists manage portfolios of claims and benefits issues and ensure that they provide the best resolutions that follow the health plan processing guidelines to impress their clients.

What does a benefit specialist do?

A benefits specialist is responsible for analyzing and processing the compensation package of an organization, ensuring that the salary and benefits received by an employee adhere to the current legislation procedures. Benefits specialists develop benefits programs, adjusting pension plans and insurance options as needed, and updating the employees on recent updates and changes. A benefits specialist responds to employees' inquiries, addresses their concerns, and manages benefits issues. A benefits specialist must have a clear understanding of benefits policies and processes to educate employees about the benefits structure.

Claims benefit specialist vs benefit specialist salary

Claims benefit specialists and benefit specialists have different pay scales, as shown below.

	Claims Benefit Specialist	Benefit Specialist
Average salary	$47,292	$48,756
Salary range	Between $32,000 And $68,000	Between $34,000 And $68,000
Highest paying City	-	San Francisco, CA
Highest paying state	-	Connecticut
Best paying company	-	Qorvo
Best paying industry	-	Finance

Differences between claims benefit specialist and benefit specialist education

There are a few differences between a claims benefit specialist and a benefit specialist in terms of educational background:

	Claims Benefit Specialist	Benefit Specialist
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 59%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Claims benefit specialist vs benefit specialist demographics

Here are the differences between claims benefit specialists' and benefit specialists' demographics:

	Claims Benefit Specialist	Benefit Specialist
Average age	44	45
Gender ratio	Male, 19.6% Female, 80.4%	Male, 21.1% Female, 78.9%
Race ratio	Black or African American, 11.4% Unknown, 4.4% Hispanic or Latino, 16.9% Asian, 5.2% White, 61.6% American Indian and Alaska Native, 0.5%	Black or African American, 11.0% Unknown, 3.6% Hispanic or Latino, 15.3% Asian, 7.5% White, 62.2% American Indian and Alaska Native, 0.3%
LGBT Percentage	10%	9%

Differences between claims benefit specialist and benefit specialist duties and responsibilities

Claims benefit specialist example responsibilities.

Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
Analyze each claim and calculate percentages for both PPO and NON-PPO providers.
Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines
Process Non-HMO and PPO paper and electronic claims in an accurate and time manner.

Benefit specialist example responsibilities.

Manage various employee program such as life, medical, dental pension, and HSA accounts.
Examine HMO documents to verify eligibility to process or reject into or from a manage care plan when necessary.
Input daily time and PTO, manage benefits, report new hires, input sales, oversee accounts receivable.
Create reports using SQL database and manage reports, perform from internet-base tools for research projects need for client insight.
Implement new vendor for FSA administration and manage outstanding issues through continuous follow-up and vendor accountability.
Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.

Claims benefit specialist vs benefit specialist skills

Common claims benefit specialist skills

Customer Inquiries, 11%
Appeals, 7%
Medical Terminology, 6%
Routine Claims, 5%
CPT, 4%
Processing Issues, 4%

Common benefit specialist skills

Customer Service, 13%
HR, 8%
Patients, 5%
HRIS, 5%
Life Insurance, 5%
Cobra, 5%

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Business and Financial Industry
Claims Benefit Specialist
Claims Benefit Specialist vs Benefit Specialist

Updated January 8, 2025

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