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Claims director vs claim processor

The differences between claims directors and claim processors 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 director and a claim processor. Additionally, a claims director has an average salary of $118,250, which is higher than the $41,201 average annual salary of a claim processor.

The top three skills for a claims director include customer service, litigation and oversight. The most important skills for a claim processor are customer service, data entry, and medical terminology.

Claims director vs claim processor overview

Claims DirectorClaim Processor
Yearly salary$118,250$41,201
Hourly rate$56.85$19.81
Growth rate-6%-6%
Number of jobs13,29911,542
Job satisfaction--
Most common degreeBachelor's Degree, 68%Bachelor's Degree, 43%
Average age4444
Years of experience66

What does a claims director do?

A claims director spearheads and oversees the daily operations of an insurance company's claims department. They have the authority to make decisions and changes, set goals and timelines, establish guidelines and budgets, liaise with key external partners, coordinate managers and teams, delegate responsibilities, and conduct research and analysis to find opportunities that will optimize the department's operations. Moreover, a claims director leads and encourages staff to reach goals, all while implementing the company's claims policies and regulations, developing new ones as needed.

What does a claim processor do?

A Claims Processor is responsible for processing and verifying insurance claims, in adherence to the policies, laws, and regulations of the company involved. Aside from examining its authenticity, they must also oversee new policies and recommend modifications should it be needed. Moreover, it is also the task of the Claims Processor to prepare the necessary documents and guidelines for the policyholder, process reimbursements upon approval, provide answers to inquiries, and report issues and updates to the management.

Claims director vs claim processor salary

Claims directors and claim processors have different pay scales, as shown below.

Claims DirectorClaim Processor
Average salary$118,250$41,201
Salary rangeBetween $73,000 And $190,000Between $26,000 And $62,000
Highest paying City-Columbia, MD
Highest paying state-Connecticut
Best paying company-NTT Data International L.L.C.
Best paying industry-Insurance

Differences between claims director and claim processor education

There are a few differences between a claims director and a claim processor in terms of educational background:

Claims DirectorClaim Processor
Most common degreeBachelor's Degree, 68%Bachelor's Degree, 43%
Most common majorBusinessBusiness
Most common collegeStanford UniversityStanford University

Claims director vs claim processor demographics

Here are the differences between claims directors' and claim processors' demographics:

Claims DirectorClaim Processor
Average age4444
Gender ratioMale, 58.2% Female, 41.8%Male, 22.9% Female, 77.1%
Race ratioBlack or African American, 10.7% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 62.2% American Indian and Alaska Native, 0.5%Black or African American, 11.2% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 62.0% American Indian and Alaska Native, 0.5%
LGBT Percentage10%10%

Differences between claims director and claim processor duties and responsibilities

Claims director example responsibilities.

  • Create project team that comply with new Medicare reporting requirements achieving successful reporting to CMS.
  • Maintain relationships with attorneys and manage litigation strategy; ensure strong relationships with insureds, brokers and third party administrators.
  • Redesign processes and procedures for managing litigation through the implementation of an aggressive process for managing discovery and case typing.
  • General knowledge of CPT, ICD-9, HCPCS, DRG and Medicode (UCR), bundling and unbundling.
  • File and respond to online arbitration matters.
  • Facilitate annual updates to all new and revise CPT codes assuring accurate claims payment.
    • Show more

Claim processor example responsibilities.

  • Experience in many facets of the managed healthcare insurance business.
  • Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
  • Use ICD-9, CPT-4 and other medical manuals to adjudicate claims.
  • Analyze claims submit by providers and facilities for appropriate ICD-9, CPT and HCPCS codes against charges that are being bill.
  • Call DME and HME companies to correct invoices.
  • Coach and assist in the training of new EMR databases.
    • Show more

Claims director vs claim processor skills

Common claims director skills
  • Customer Service, 17%
  • Litigation, 11%
  • Oversight, 9%
  • Coverage Issues, 6%
  • Claims Handling, 5%
  • Claims Operations, 5%
Common claim processor skills
  • Customer Service, 20%
  • Data Entry, 8%
  • Medical Terminology, 5%
  • CPT, 5%
  • Claims Processing, 4%
  • Medical Insurance Claims, 4%

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Updated January 8, 2025

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