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The differences between claims resolution specialists and claim specialists can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 6-12 months to become a claims resolution specialist, becoming a claim specialist takes usually requires 4-6 years. Additionally, a claim specialist has an average salary of $43,164, which is higher than the $38,432 average annual salary of a claims resolution specialist.
The top three skills for a claims resolution specialist include patients, medical terminology and insurance claims. The most important skills for a claim specialist are customer service, litigation, and patients.
| Claims Resolution Specialist | Claim Specialist | |
| Yearly salary | $38,432 | $43,164 |
| Hourly rate | $18.48 | $20.75 |
| Growth rate | -4% | -6% |
| Number of jobs | 55,413 | 29,505 |
| Job satisfaction | - | - |
| Most common degree | Bachelor's Degree, 52% | Bachelor's Degree, 54% |
| Average age | 40 | 44 |
| Years of experience | 12 | 6 |
Claims resolution specialists are in charge of outstanding claims follow-ups, submitting appeals, and corresponding to work claims. To be good at this job, they find different techniques to resolve outstanding patient claims. When performing their duties, these specialists make sure that they work with professionalism and high detail quality. They should be comfortable with navigating computerized claims and various platforms while assisting their clients over the phone. These types of specialists also always maintain the confidentiality of their members' data.
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 resolution specialists and claim specialists have different pay scales, as shown below.
| Claims Resolution Specialist | Claim Specialist | |
| Average salary | $38,432 | $43,164 |
| Salary range | Between $30,000 And $47,000 | 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 |
There are a few differences between a claims resolution specialist and a claim specialist in terms of educational background:
| Claims Resolution Specialist | Claim Specialist | |
| Most common degree | Bachelor's Degree, 52% | Bachelor's Degree, 54% |
| Most common major | Business | Business |
| Most common college | - | Stanford University |
Here are the differences between claims resolution specialists' and claim specialists' demographics:
| Claims Resolution Specialist | Claim Specialist | |
| Average age | 40 | 44 |
| Gender ratio | Male, 26.0% Female, 74.0% | Male, 31.0% Female, 69.0% |
| Race ratio | Black or African American, 11.4% Unknown, 5.1% Hispanic or Latino, 20.6% Asian, 6.2% White, 56.0% American Indian and Alaska Native, 0.6% | 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 | 7% | 10% |