Claims director vs claims benefit specialist

The differences between claims directors and claims 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 director and a claims benefit specialist. Additionally, a claims director has an average salary of $118,250, which is higher than the $47,292 average annual salary of a claims benefit specialist.

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

Claims director vs claims benefit specialist overview

	Claims Director	Claims Benefit Specialist
Yearly salary	$118,250	$47,292
Hourly rate	$56.85	$22.74
Growth rate	-6%	-6%
Number of jobs	13,299	32,208
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 68%	Bachelor's Degree, 40%
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 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.

Claims director vs claims benefit specialist salary

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

	Claims Director	Claims Benefit Specialist
Average salary	$118,250	$47,292
Salary range	Between $73,000 And $190,000	Between $32,000 And $68,000
Highest paying City	-	-
Highest paying state	-	-
Best paying company	-	-
Best paying industry	-	-

Differences between claims director and claims benefit specialist education

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

	Claims Director	Claims Benefit Specialist
Most common degree	Bachelor's Degree, 68%	Bachelor's Degree, 40%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claims director vs claims benefit specialist demographics

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

	Claims Director	Claims Benefit Specialist
Average age	44	44
Gender ratio	Male, 58.2% Female, 41.8%	Male, 19.6% Female, 80.4%
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, 16.9% Asian, 5.2% White, 61.6% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims director and claims benefit 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.

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.

Claims director vs claims benefit specialist skills

Common claims director skills

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

Common claims benefit specialist skills

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

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Claims Director
Claims Director vs Claims Benefit Specialist

Updated January 8, 2025

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