Claims benefit specialist vs liability claims representative

The differences between claims benefit specialists and liability claims representatives 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 liability claims representative. Additionally, a claims benefit specialist has an average salary of $47,292, which is higher than the $45,654 average annual salary of a liability claims representative.

The top three skills for a claims benefit specialist include customer inquiries, appeals and medical terminology. The most important skills for a liability claims representative are litigation, claims handling, and customer service.

Claims benefit specialist vs liability claims representative overview

	Claims Benefit Specialist	Liability Claims Representative
Yearly salary	$47,292	$45,654
Hourly rate	$22.74	$21.95
Growth rate	-6%	-6%
Number of jobs	32,208	13,563
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 81%
Average age	44	44
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 liability claims representative do?

A liability claims representative works at insurance companies where they are in charge of processing and settling insurance claims, ensuring accurate and efficient client service. They are responsible for conducting assessments, reviewing reports from examiners, and tracking any discrepancies such as underpayment or overpayment, reporting them right away. There are also times when they must meet with clients and inspect damages, conduct interviews and evaluations, estimate and negotiate settlements with external parties, and coordinate with other professionals to gain insights. Moreover, a liability claims representative maintains an active communication line with staff, resolving issues in a timely manner.

Claims benefit specialist vs liability claims representative salary

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

	Claims Benefit Specialist	Liability Claims Representative
Average salary	$47,292	$45,654
Salary range	Between $32,000 And $68,000	Between $33,000 And $61,000
Highest paying City	-	Somerville, MA
Highest paying state	-	New Jersey
Best paying company	-	The Travelers Companies
Best paying industry	-	Insurance

Differences between claims benefit specialist and liability claims representative education

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

	Claims Benefit Specialist	Liability Claims Representative
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 81%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claims benefit specialist vs liability claims representative demographics

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

	Claims Benefit Specialist	Liability Claims Representative
Average age	44	44
Gender ratio	Male, 19.6% Female, 80.4%	Male, 43.1% Female, 56.9%
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, 11.5% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 61.7% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims benefit specialist and liability claims representative 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.

Liability claims representative example responsibilities.

Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
Investigate and conclude property and casualty liability claims including those in litigation with the highest overall production of the claims representatives.
Participate in arbitration hearings through writing contentions, compiling evidence and personally representing files.
Control expenses by developing and following resolutions and/or litigation plans to drive claim to resolution.
Facilitate training seminars for new employees to familiarize them with various corporate procedures including exposure recognition, fraud detection and arbitration.
Complete field inspection of losses including accurate scope of damages, photographic evidence collection, written estimates utilizing Xactimate estimating software.

Claims benefit specialist vs liability claims representative skills

Common claims benefit specialist skills

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

Common liability claims representative skills

Litigation, 9%
Claims Handling, 8%
Customer Service, 7%
Law Enforcement Agencies, 6%
Insurance Claims, 6%
Reservations, 6%

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Claims Benefit Specialist
Claims Benefit Specialist vs Liability Claims Representative

Updated January 8, 2025

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