Claims reviewer vs claim processor

The differences between claims reviewers and claim processors 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 reviewer, becoming a claim processor takes usually requires 4-6 years. Additionally, a claim processor has an average salary of $41,201, which is higher than the $41,011 average annual salary of a claims reviewer.

The top three skills for a claims reviewer include home health, insurance claims and data entry. The most important skills for a claim processor are customer service, data entry, and medical terminology.

Claims reviewer vs claim processor overview

	Claims Reviewer	Claim Processor
Yearly salary	$41,011	$41,201
Hourly rate	$19.72	$19.81
Growth rate	-4%	-6%
Number of jobs	9,789	11,542
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 55%	Bachelor's Degree, 43%
Average age	40	44
Years of experience	12	6

Claims reviewer vs claim processor salary

Claims reviewers and claim processors have different pay scales, as shown below.

	Claims Reviewer	Claim Processor
Average salary	$41,011	$41,201
Salary range	Between $30,000 And $54,000	Between $26,000 And $62,000
Highest paying City	-	Columbia, MD
Highest paying state	-	Connecticut
Best paying company	-	NTT Data International L.L.C.
Best paying industry	-	Insurance

Differences between claims reviewer and claim processor education

There are a few differences between a claims reviewer and a claim processor in terms of educational background:

	Claims Reviewer	Claim Processor
Most common degree	Bachelor's Degree, 55%	Bachelor's Degree, 43%
Most common major	Business	Business
Most common college	-	Stanford University

Claims reviewer vs claim processor demographics

Here are the differences between claims reviewers' and claim processors' demographics:

	Claims Reviewer	Claim Processor
Average age	40	44
Gender ratio	Male, 30.2% Female, 69.8%	Male, 22.9% Female, 77.1%
Race ratio	Black or African American, 15.5% Unknown, 5.0% Hispanic or Latino, 16.3% Asian, 7.2% White, 55.4% American Indian and Alaska Native, 0.6%	Black or African American, 11.2% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 62.0% American Indian and Alaska Native, 0.5%
LGBT Percentage	7%	10%

Differences between claims reviewer and claim processor duties and responsibilities

Claims reviewer example responsibilities.

Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
Review worker comp claims base on state fee schedule and ICD-9 guidelines.
Research ICD-9 codes and verify they are equivalent with customer s diagnoses.
Review accounts per OCC guidelines that all efforts are met and due diligence complete.
Research claims, review document findings and execute OCC approve harm test for each file.
Help maintain company compliance with FDA and ICH Regulations/Guidelines governing the reporting of adverse event reports.

Claim processor example responsibilities.

Experience in many facets of the managed healthcare insurance business.
Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
Use ICD-9, CPT-4 and other medical manuals to adjudicate claims.
Analyze claims submit by providers and facilities for appropriate ICD-9, CPT and HCPCS codes against charges that are being bill.
Call DME and HME companies to correct invoices.
Coach and assist in the training of new EMR databases.

Claims reviewer vs claim processor skills

Common claims reviewer skills

Home Health, 50%
Insurance Claims, 5%
Data Entry, 5%
Medical Terminology, 3%
CPT, 3%
Claims Submission, 3%

Common claim processor skills

Customer Service, 20%
Data Entry, 8%
Medical Terminology, 5%
CPT, 5%
Claims Processing, 4%
Medical Insurance Claims, 4%