Claims director vs claim specialist

The differences between claims directors and claim 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 director and a claim specialist. Additionally, a claims director has an average salary of $118,250, which is higher than the $43,164 average annual salary of a claim specialist.

The top three skills for a claims director include customer service, litigation and oversight. The most important skills for a claim specialist are customer service, litigation, and patients.

Claims director vs claim specialist overview

	Claims Director	Claim Specialist
Yearly salary	$118,250	$43,164
Hourly rate	$56.85	$20.75
Growth rate	-6%	-6%
Number of jobs	13,299	29,505
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 68%	Bachelor's Degree, 54%
Average age	44	44
Years of experience	6	6

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 specialist do?

A claims specialist is responsible for processing insurance claims, reviewing insurance coverage, and analyzing claims cases. Claims specialists' duties include negotiating claims settlements, validating claims to prevent fraud, creating court testimonies as needed, developing claim review plans, and checking necessary documents and related resolve claims. A claims specialist must have strong analytical and critical-thinking skills to authorize claim payment and investigate complex and unusual claims. Claims specialists should also have extensive knowledge of the insurance processes to handle various cases, following legal policies and regulatory procedures.

Claims director vs claim specialist salary

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

	Claims Director	Claim Specialist
Average salary	$118,250	$43,164
Salary range	Between $73,000 And $190,000	Between $27,000 And $67,000
Highest paying City	-	Newark, NJ
Highest paying state	-	New Jersey
Best paying company	-	W. R. Berkley
Best paying industry	-	Insurance

Differences between claims director and claim specialist education

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

	Claims Director	Claim Specialist
Most common degree	Bachelor's Degree, 68%	Bachelor's Degree, 54%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claims director vs claim specialist demographics

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

	Claims Director	Claim Specialist
Average age	44	44
Gender ratio	Male, 58.2% Female, 41.8%	Male, 31.0% Female, 69.0%
Race ratio	Black 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, 11.4% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.1% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims director and claim specialist 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.

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Claim specialist example responsibilities.

Assist in the streamlining of EDI process to manage workflow of EDI claims.
Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
Manage expedition of appeals via problem solving and collaboration with other departments.

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Claims director vs claim specialist skills

Common claims director skills

Customer Service, 17%
Litigation, 11%
Oversight, 9%
Coverage Issues, 6%
Claims Handling, 5%
Claims Operations, 5%

Common claim specialist skills

Customer Service, 19%
Litigation, 7%
Patients, 5%
Claims Handling, 4%
Quality Standards, 4%
Excellent Organizational, 4%

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Updated January 8, 2025

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