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Claims resolution specialist vs service specialist

The differences between claims resolution specialists and service specialists can be seen in a few details. Each job has different responsibilities and duties. It typically takes 6-12 months to become both a claims resolution specialist and a service specialist. Additionally, a service specialist has an average salary of $44,150, 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 service specialist are patients, social work, and criminal justice.

Claims resolution specialist vs service specialist overview

Claims Resolution SpecialistService Specialist
Yearly salary$38,432$44,150
Hourly rate$18.48$21.23
Growth rate-4%-4%
Number of jobs55,413207,020
Job satisfaction--
Most common degreeBachelor's Degree, 52%Bachelor's Degree, 53%
Average age4040
Years of experience1212

What does a claims resolution specialist do?

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.

What does a service specialist do?

A service specialist is responsible for assisting customers with their inquiries and concerns about the services offered by the organization. Service specialists' duties include responding to customers' requests, updating customers of promotional offers and new services, escalating high-level concerns to the appropriate department, and keeping accurate records of clients' issues and resolutions. Service specialists are also in charge of preparing customer surveys to rate their satisfaction and identifying opportunities for service improvement. A service specialist must display excellent customer service and communication skills to address clients' concerns efficiently and accurately.

Claims resolution specialist vs service specialist salary

Claims resolution specialists and service specialists have different pay scales, as shown below.

Claims Resolution SpecialistService Specialist
Average salary$38,432$44,150
Salary rangeBetween $30,000 And $47,000Between $27,000 And $71,000
Highest paying City-Boston, MA
Highest paying state-Massachusetts
Best paying company-Ropes & Gray
Best paying industry-Technology

Differences between claims resolution specialist and service specialist education

There are a few differences between a claims resolution specialist and a service specialist in terms of educational background:

Claims Resolution SpecialistService Specialist
Most common degreeBachelor's Degree, 52%Bachelor's Degree, 53%
Most common majorBusinessBusiness
Most common college--

Claims resolution specialist vs service specialist demographics

Here are the differences between claims resolution specialists' and service specialists' demographics:

Claims Resolution SpecialistService Specialist
Average age4040
Gender ratioMale, 26.0% Female, 74.0%Male, 40.1% Female, 59.9%
Race ratioBlack 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, 11.2% Unknown, 5.4% Hispanic or Latino, 20.9% Asian, 7.5% White, 54.2% American Indian and Alaska Native, 0.7%
LGBT Percentage7%7%

Differences between claims resolution specialist and service specialist duties and responsibilities

Claims resolution specialist example responsibilities.

  • Manage expedition of appeals via problem solving and collaboration with other departments.
  • Assist provider with ICD-9, CPT and revenue codes, DME, coordination of benefits, efficiently train on HIPPA.
  • Process medical claims submit to Kansas Medicaid using establish guidelines and policies.
  • Ensure compliance with HIPAA regulations and requirements.
  • Determine the types of claims using submit diagnoses, CPT, and HCPS codes.
  • Communicate with claimants and insure individuals alike while ensuring privacy and HIPPA laws are maintain.
  • Show more

Service specialist example responsibilities.

  • Achieve personal sales and referral goals by identifying, marketing and cross-selling banking products and services beneficial to customer needs.
  • Educate veterans and the college community on veteran's benefits and academic requirements need to accomplish academic goals.
  • Provide notary service as requested.
  • Respond to medical emergencies, including first aid and CPR.
  • Organize the transition of file transfers of major TRS/NAS clients from FTP to MessageWay.
  • Follow all rules set by FDCPA and state agencies - pass all annual tests.
  • Show more

Claims resolution specialist vs service specialist skills

Common claims resolution specialist skills
  • Patients, 13%
  • Medical Terminology, 7%
  • Insurance Claims, 6%
  • Patient Accounts, 5%
  • Medicaid, 5%
  • CPT, 5%
Common service specialist skills
  • Patients, 12%
  • Social Work, 10%
  • Criminal Justice, 4%
  • Rehabilitation, 4%
  • Excellent Interpersonal, 4%
  • Product Knowledge, 3%

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