Claims benefit specialist vs medical claims analyst

The differences between claims benefit specialists and medical claims analysts 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 medical claims analyst. Additionally, a claims benefit specialist has an average salary of $47,292, which is higher than the $46,708 average annual salary of a medical claims analyst.

The top three skills for a claims benefit specialist include customer inquiries, appeals and medical terminology. The most important skills for a medical claims analyst are medical terminology, medicaid, and medical insurance claims.

Claims benefit specialist vs medical claims analyst overview

	Claims Benefit Specialist	Medical Claims Analyst
Yearly salary	$47,292	$46,708
Hourly rate	$22.74	$22.46
Growth rate	-6%	-6%
Number of jobs	32,208	65,897
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 36%
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 medical claims analyst do?

A medical claims analyst audits or verifies medical claims in insurance companies. Medical claims analysts make sure that corporate reimbursement payments are accurate. Usually, they work at an office on a computer workstation. They receive Medicaid claims from specialty and medical providers for reimbursement. Their job includes the development of an enhanced procedure in handling difficult Medicare/Medicaid letters while complying with the set policies.

Claims benefit specialist vs medical claims analyst salary

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

	Claims Benefit Specialist	Medical Claims Analyst
Average salary	$47,292	$46,708
Salary range	Between $32,000 And $68,000	Between $32,000 And $68,000
Highest paying City	-	Bridgewater, NJ
Highest paying state	-	New Jersey
Best paying company	-	Montefiore Mount Vernon Hospital
Best paying industry	-	Insurance

Differences between claims benefit specialist and medical claims analyst education

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

	Claims Benefit Specialist	Medical Claims Analyst
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 36%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Claims benefit specialist vs medical claims analyst demographics

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

	Claims Benefit Specialist	Medical Claims Analyst
Average age	44	44
Gender ratio	Male, 19.6% Female, 80.4%	Male, 14.2% Female, 85.8%
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, 11.2% Unknown, 4.4% Hispanic or Latino, 16.4% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims benefit specialist and medical claims analyst 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.

Medical claims analyst example responsibilities.

Manage cases by aggressively directing the litigation process.
Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.

Claims benefit specialist vs medical claims analyst skills

Common claims benefit specialist skills

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

Common medical claims analyst skills

Medical Terminology, 9%
Medicaid, 6%
Medical Insurance Claims, 6%
Customer Service, 6%
Data Entry, 6%
Patients, 5%

Claims Benefit Specialist vs. similar jobs

Claims Benefit Specialist related careers

Claims Benefit Specialist related jobs

What similar roles do

Zippia Careers
Business and Financial Industry
Claims Benefit Specialist
Claims Benefit Specialist vs Medical Claims Analyst

Updated January 8, 2025

Browse business and financial jobs