Claims director vs medical claims examiner

The differences between claims directors and medical claims examiners 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 medical claims examiner. Additionally, a claims director has an average salary of $118,250, which is higher than the $42,773 average annual salary of a medical claims examiner.

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

Claims director vs medical claims examiner overview

	Claims Director	Medical Claims Examiner
Yearly salary	$118,250	$42,773
Hourly rate	$56.85	$20.56
Growth rate	-6%	-6%
Number of jobs	13,299	57,125
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 68%	Bachelor's Degree, 36%
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 medical claims examiner do?

A medical claims examiner determines whether an insurer will be covering losses from accidents and illness. They are responsible for evaluating insurance claims and applications, following up with insurance adjusters to protect an insurer from financial loss, ensuring information integrity, and ensuring standard guidelines are adhered to. They are also tasked with approving payment and facilitating additional investigation. Qualifications for this position include knowledge of medical terminology.

Claims director vs medical claims examiner salary

Claims directors and medical claims examiners have different pay scales, as shown below.

	Claims Director	Medical Claims Examiner
Average salary	$118,250	$42,773
Salary range	Between $73,000 And $190,000	Between $30,000 And $59,000
Highest paying City	-	Los Angeles, CA
Highest paying state	-	New Jersey
Best paying company	-	UST Global
Best paying industry	-	Technology

Differences between claims director and medical claims examiner education

There are a few differences between a claims director and a medical claims examiner in terms of educational background:

	Claims Director	Medical Claims Examiner
Most common degree	Bachelor's Degree, 68%	Bachelor's Degree, 36%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Claims director vs medical claims examiner demographics

Here are the differences between claims directors' and medical claims examiners' demographics:

	Claims Director	Medical Claims Examiner
Average age	44	44
Gender ratio	Male, 58.2% Female, 41.8%	Male, 16.6% Female, 83.4%
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, 10.5% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims director and medical claims examiner 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.

Medical claims examiner example responsibilities.

Manage cases by aggressively directing the litigation process.
Process medical facility claims payment according to account-specific contract (HMO, PPO, EPO, etc . )
Process PPO, HMO, comprehensive plans, including medicare supplements, hospital, chiropractic and physical therapy claims.
Identify which claims are eligible for PPO reprising.
Resolve medical claims by approving and/or denying base on CMS guidelines for Medicaid/Medicare claim processing.
Verify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.

Claims director vs medical claims examiner skills

Common claims director skills

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

Common medical claims examiner skills

Medical Terminology, 10%
Customer Service, 9%
Data Entry, 7%
Medical Treatment, 5%
Computer System, 5%
Provider Contracts, 4%

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Claims Director vs Medical Claims Examiner

Updated January 8, 2025

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