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Claims representative vs claims analyst

The differences between claims representatives and 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 representative and a claims analyst. Additionally, a claims analyst has an average salary of $48,398, which is higher than the $38,796 average annual salary of a claims representative.

The top three skills for a claims representative include customer service, quality standards and policy coverage. The most important skills for a claims analyst are customer service, medical terminology, and CPT.

Claims representative vs claims analyst overview

Claims RepresentativeClaims Analyst
Yearly salary$38,796$48,398
Hourly rate$18.65$23.27
Growth rate-6%-6%
Number of jobs18,56522,062
Job satisfaction--
Most common degreeBachelor's Degree, 62%Bachelor's Degree, 52%
Average age4444
Years of experience66

What does a claims representative do?

A Claims Representative is an agent who works for insurance companies in order to investigate and settle claims. The agent acts as an intermediary between customers and insurance companies by evaluating the customers' facts surrounding claims and determining whether the loss is covered or should be compensated. Such a role is important because an agent makes sure that no fraud claims are being paid out. It is also highlighted that an agent works in compliance with state regulations.

What does a claims analyst do?

A claims analyst specializes in processing medical insurance claims. They are primarily responsible for verifying the authenticity and eligibility of claims, analyzing the billing, communicating with policyholders, and ensuring adherence to all the policies and regulations during the entire procedure. Furthermore, a claims analyst is also in charge of administrative tasks such as keeping and updating records, reaching out and sending reports to creditors, setting appointments and schedules, processing paperwork, coordinating with key personnel, and discussing terms and necessary information to clients.

Claims representative vs claims analyst salary

Claims representatives and claims analysts have different pay scales, as shown below.

Claims RepresentativeClaims Analyst
Average salary$38,796$48,398
Salary rangeBetween $28,000 And $53,000Between $29,000 And $78,000
Highest paying CityDearborn, MITrenton, NJ
Highest paying stateNew JerseyNew Jersey
Best paying companyW. R. BerkleyGoogle
Best paying industryGovernment-

Differences between claims representative and claims analyst education

There are a few differences between a claims representative and a claims analyst in terms of educational background:

Claims RepresentativeClaims Analyst
Most common degreeBachelor's Degree, 62%Bachelor's Degree, 52%
Most common majorBusinessBusiness
Most common collegeStanford UniversityStanford University

Claims representative vs claims analyst demographics

Here are the differences between claims representatives' and claims analysts' demographics:

Claims RepresentativeClaims Analyst
Average age4444
Gender ratioMale, 37.5% Female, 62.5%Male, 27.6% Female, 72.4%
Race ratioBlack or African American, 11.0% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%Black or African American, 11.3% Unknown, 4.4% Hispanic or Latino, 16.4% Asian, 5.1% White, 62.3% American Indian and Alaska Native, 0.5%
LGBT Percentage10%10%

Differences between claims representative and claims analyst duties and responsibilities

Claims representative example responsibilities.

  • Perform initial set-up and continuously manage claims in the Juris claims management system.
  • Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
  • Prepare necessary state filings within statutory limits, manage litigation and vocational rehabilitation process, used appropriate cost containment techniques.
  • Assist the training department in developing CSR training in order to set expectations.
  • Create custom templates and guide sheets for new trainees in the CSR Internet division to ensure consistency and increase department efficiency.
  • Utilize proper SIU reporting procedures for extensive investigation as required.
    • Show more

Claims analyst example responsibilities.

  • Help managed meetings regarding decision making on CMS regulations.
  • Process UB's and HCFA's according to guidelines.
  • Analyze and investigate medical claims utilizing ICD-9 and CPT-4 coding.
  • Review claims (HCFA and UB) for accurate billing submission.
  • Interpret medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes for member submit claims.
  • Acquire biometrics and perform phlebotomy.
    • Show more

Claims representative vs claims analyst skills

Common claims representative skills
  • Customer Service, 26%
  • Quality Standards, 6%
  • Policy Coverage, 6%
  • Reservations, 5%
  • Claims Handling, 3%
  • Insurance Coverage, 3%
Common claims analyst skills
  • Customer Service, 14%
  • Medical Terminology, 5%
  • CPT, 5%
  • Process Claims, 5%
  • Medicaid, 5%
  • Data Entry, 5%

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Updated January 8, 2025

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