Claims service representative vs patient service representative

The differences between claims service representatives and patient service representatives 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 service representative, becoming a patient service representative takes usually requires 2-4 years. Additionally, a claims service representative has an average salary of $36,043, which is higher than the $32,476 average annual salary of a patient service representative.

The top three skills for a claims service representative include insurance claims, customer service and policy coverage. The most important skills for a patient service representative are patients, customer service, and excellent interpersonal.

Claims service representative vs patient service representative overview

	Claims Service Representative	Patient Service Representative
Yearly salary	$36,043	$32,476
Hourly rate	$17.33	$15.61
Growth rate	-4%	-4%
Number of jobs	127,339	165,920
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 32%
Average age	40	40
Years of experience	12	4

What does a claims service representative do?

Claims service representatives evaluate customer insurance claims. Their tasks in this career include interviewing witnesses or customers and visiting accident sites to assess the scope of the claim. Also, they determine whether it is worth arranging a settlement and make sure all settlement claims are managed quickly. In addition to evaluating accidents and claims, they renew customer policies based on their history. Qualifications for the job include a firm knowledge of overall company policy, computer literacy, and excellent customer service.

What does a patient service representative do?

A Patient Service Representative is responsible for coordinating with patients, ensuring accuracy and satisfaction at all times. The duties of a Patient Service Representative revolves around greeting and responding to patients, offering assistance in documentation, gathering and maintaining their personal information, and even communicating with the family or guardian. They also have to collect payments and process insurance details, obtain medical history, and even keep the patients updated in various aspects. Aside from this, it is crucial for a Representative coordinate with supervisors or personnel in-charge at all times.

Claims service representative vs patient service representative salary

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

	Claims Service Representative	Patient Service Representative
Average salary	$36,043	$32,476
Salary range	Between $30,000 And $42,000	Between $27,000 And $38,000
Highest paying City	Urban Honolulu, HI	Seattle, WA
Highest paying state	Alaska	Vermont
Best paying company	Homeowners Choice	University of California, Berkeley
Best paying industry	Government	Health Care

Differences between claims service representative and patient service representative education

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

	Claims Service Representative	Patient Service Representative
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 32%
Most common major	Business	Business
Most common college	-	University of Pennsylvania

Claims service representative vs patient service representative demographics

Here are the differences between claims service representatives' and patient service representatives' demographics:

	Claims Service Representative	Patient Service Representative
Average age	40	40
Gender ratio	Male, 29.2% Female, 70.8%	Male, 11.9% Female, 88.1%
Race ratio	Black or African American, 12.8% Unknown, 5.2% Hispanic or Latino, 19.9% Asian, 6.1% White, 55.3% American Indian and Alaska Native, 0.7%	Black or African American, 10.3% Unknown, 5.3% Hispanic or Latino, 21.5% Asian, 6.3% White, 55.7% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between claims service representative and patient service representative duties and responsibilities

Claims service representative example responsibilities.

Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
Experience in medical terminology, ICD9, CPT and DRG coding.
Review types of service on claims base on the CPT codes and diagnosis code.
Examine injure persons and administer first aid or cardiopulmonary resuscitation, if necessary, using training and medical supplies and equipment.
Coordinate EDI traffic with external clearinghouses and business partner Multiplan.
Process EDI reports, purge reports, and smart data reject list.

Patient service representative example responsibilities.

Manage the daily release of charges to A/R.
Adhere with all state and federal regulations such as EMTALA and HIPPA requirements and appropriately collect co-payments and deductibles from patients.
Provide caring and compassion to elderly and developmentally disable patients.
Demonstrate respect, compassion and confidentiality for patients and family members.
Provide professional and accurate service to schedule patient appointments, check-in and verify insurance eligibility.
Provide quality customer service to patients and observe all protocols regarding HIPPA regulations to ensure patient confidentiality.

Claims service representative vs patient service representative skills

Common claims service representative skills

Insurance Claims, 12%
Customer Service, 11%
Policy Coverage, 8%
Phone Calls, 7%
Claims Process, 6%
Inbound Calls, 4%

Common patient service representative skills

Patients, 20%
Customer Service, 12%
Excellent Interpersonal, 7%
Check-In, 7%
Patient Service, 6%
Excellent Organizational, 6%

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Office and Administrative Industry
Claims Service Representative
Claims Service Representative vs Patient Service Representative

Updated January 8, 2025

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