Claims reviewer vs representative

The differences between claims reviewers and representatives 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 reviewer and a representative. Additionally, a claims reviewer has an average salary of $41,011, which is higher than the $36,023 average annual salary of a representative.

The top three skills for a claims reviewer include home health, insurance claims and data entry. The most important skills for a representative are cleanliness, patients, and customer issues.

Claims reviewer vs representative overview

	Claims Reviewer	Representative
Yearly salary	$41,011	$36,023
Hourly rate	$19.72	$17.32
Growth rate	-4%	-4%
Number of jobs	9,789	252,761
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 55%	Bachelor's Degree, 53%
Average age	40	40
Years of experience	12	12

Claims reviewer vs representative salary

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

	Claims Reviewer	Representative
Average salary	$41,011	$36,023
Salary range	Between $30,000 And $54,000	Between $23,000 And $55,000
Highest paying City	-	Washington, DC
Highest paying state	-	New York
Best paying company	-	Google
Best paying industry	-	Transportation

Differences between claims reviewer and representative education

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

	Claims Reviewer	Representative
Most common degree	Bachelor's Degree, 55%	Bachelor's Degree, 53%
Most common major	Business	Business
Most common college	-	-

Claims reviewer vs representative demographics

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

	Claims Reviewer	Representative
Average age	40	40
Gender ratio	Male, 30.2% Female, 69.8%	Male, 41.8% Female, 58.2%
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, 11.0% Unknown, 5.4% Hispanic or Latino, 20.9% Asian, 7.5% White, 54.4% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between claims reviewer and representative 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.

Representative example responsibilities.

Manage fitting rooms and recover the department, while providing exceptional customer service and offering rewards and POS options.
Manage physical portfolio with necessary derivatives to mitigate risk within company guidelines.
Conduct telephone sales and interviews, compile and enter information into database, manage documents and insure customer satisfaction.
Review EOB denials, appeals and/or rebilling as appropriate.
Certify of all requirements, policies, and procedures, including MSB.
Take inbound phone calls from member and providers explaining the EOB denial and payments

Claims reviewer vs representative skills

Common claims reviewer skills

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

Common representative skills

Cleanliness, 20%
Patients, 11%
Customer Issues, 10%
Customer Service, 10%
Data Entry, 6%
Outbound Calls, 3%