What does a claims technician do?
Claims technicians are professionals who are responsible for paying out claims to their policyholders by gathering and checking claim details and making sure that the premium has been paid. These technicians must issue claim forms or using the telephone to gather more information from their policyholders. They are required to arrange the immediate payment of claims if they are straightforward and within the terms of a standard policy. Claims technicians must also study proposal forms when they receive a request from brokers or potential customers.
Claims technician responsibilities
Here are examples of responsibilities from real claims technician resumes:
- Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
- Provide codes for medical policies using ICD-9, CPT and HCPCS.
- Interpret body parts for workers comp claims with correct CPT and ICD-9 codes.
- Maintain client privacy by keeping protect health information confidential and complying to HIPAA policies.
- Verify Medicare and Medicaid eligibility and mail room duties.
- Complete field inspection of losses including accurate scope of damages, photographic evidence collection, written estimates utilizing Xactimate estimating software.
- Audit claims to ensure the claim procedures are correct base on GEICO's regulations and payments are accurate.
Claims technician skills and personality traits
We calculated that 21% of Claims Technicians are proficient in Data Entry, Veterans, and Customer Service. They’re also known for soft skills such as Organizational skills, Math skills, and Communication skills.
We break down the percentage of Claims Technicians that have these skills listed on their resume here:
- Data Entry, 21%
Reviewed and maintained all required data entry programs to insure all demographic information are accurate.
- Veterans, 16%
Verify Medicare eligibility for Military Service Connected or Non-Service Connected Veterans.
- Customer Service, 11%
Provided excellent customer service to providers either via telephone or personal contacts.
- Processing Claims, 6%
Performed administrative clerical tasks associated with processing claims such as establishing and maintaining files and folders and generating required correspondence.
- Medical Terminology, 5%
Completed and mastered Medical Terminology coursework.
- CPT, 4%
Make complex eligibility determinations regarding payment of claims based on CPT methodology, ICD-9 protocol and information found in appropriate.
Most claims technicians use their skills in "data entry," "veterans," and "customer service" to do their jobs. You can find more detail on essential claims technician responsibilities here:
Organizational skills. One of the key soft skills for a claims technician to have is organizational skills. You can see how this relates to what claims technicians do because "financial clerks must be able to arrange files so they can find them quickly and efficiently." Additionally, a claims technician resume shows how claims technicians use organizational skills: "provided timely, accurate, and fair resolution of claims, adhering to organizational policies and state regulations. "
Math skills. Many claims technician duties rely on math skills. "the job duties of financial clerks includes calculating charges and updating financial records.," so a claims technician will need this skill often in their role. This resume example is just one of many ways claims technician responsibilities rely on math skills: "determined policy coverage by the usage of mathematical formulas and the review of policy rules and clauses. "
Communication skills. This is an important skill for claims technicians to perform their duties. For an example of how claims technician responsibilities depend on this skill, consider that "financial clerks should be able to explain policies and procedures to colleagues and customers." This excerpt from a resume also shows how vital it is to everyday roles and responsibilities of a claims technician: "meet deadlines for arbitrations, communication, and state required correspondence. ".
The three companies that hire the most claims technicians are:
- Kelly Services7 claims technicians jobs
- The Plymouth Rock Company Incorporated7 claims technicians jobs
- HCSC6 claims technicians jobs
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Compare different claims technicians
Claims technician vs. Medical records clerk
Medical records clerks are employees in hospitals or clinics who manage office records. They are in charge of creating, updating, and filing patient-related medical records and other related documents. They ensure that all documents are correctly filled out and labeled before storing them safely in their respective storage areas. They may also be in charge of digitizing forms for easier access to files and back up purposes. They ensure that medical records are exact and updated. Medical records clerks should be organized and must always be on top of all tasks related to patient or medical records.
While similarities exist, there are also some differences between claims technicians and medical records clerk. For instance, claims technician responsibilities require skills such as "veterans," "processing claims," "process improvement," and "medical claims." Whereas a medical records clerk is skilled in "patients," "patient care," "basic math," and "math." This is part of what separates the two careers.
Medical records clerks tend to make the most money working in the health care industry, where they earn an average salary of $32,510. In contrast, claims technicians make the biggest average salary, $36,417, in the insurance industry.The education levels that medical records clerks earn slightly differ from claims technicians. In particular, medical records clerks are 2.1% less likely to graduate with a Master's Degree than a claims technician. Additionally, they're 0.1% more likely to earn a Doctoral Degree.Claims technician vs. Medical biller coder
A medical biller coder is responsible for handling the billing processes and insurance within a hospital, clinic, or similar facility. They must gather patient information and records to analyze and translate them into codes according to the insurance and medical guidelines. Moreover, it is crucial to verify all patient forms and ensure their accuracy as it will serve as a basis on essential documents and medical record-keeping. There may also be instances where a medical biller coder must devise payment plans for patients, communicate with families and guardians, and coordinate with physicians.
Each career also uses different skills, according to real claims technician resumes. While claims technician responsibilities can utilize skills like "veterans," "processing claims," "cpt," and "process improvement," medical biller coders use skills like "patients," "medical billing," "icd-10," and "cpt-4."
On average, medical biller coders earn a lower salary than claims technicians. Some industries support higher salaries in each profession. Interestingly enough, medical biller coders earn the most pay in the professional industry with an average salary of $39,875. Whereas claims technicians have higher pay in the insurance industry, with an average salary of $36,417.Average education levels between the two professions vary. Medical biller coders tend to reach similar levels of education than claims technicians. In fact, they're 2.5% less likely to graduate with a Master's Degree and 0.1% more likely to earn a Doctoral Degree.Claims technician vs. Medical coder
A medical coder's role is to interpret and analyze a patient's medical record and translate particular details according to the universal medical alphanumeric code. Moreover, a medical coder is primarily responsible for ensuring that the translations are accurate, as this will play a vital factor in processing insurance and receiving treatments. Aside from accuracy, it is also crucial for a medical coder to coordinate with other hospital personnel at all times, especially when there inconsistencies in the records.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a claims technician is likely to be skilled in "veterans," "customer service," "processing claims," and "cpt," while a typical medical coder is skilled in "cpc," "icd-10-cm," "ahima," and "patients."
Medical coders make a very good living in the health care industry with an average annual salary of $52,925. On the other hand, claims technicians are paid the highest salary in the insurance industry, with average annual pay of $36,417.When it comes to education, medical coders tend to earn similar degree levels compared to claims technicians. In fact, they're 0.8% less likely to earn a Master's Degree, and 0.5% less likely to graduate with a Doctoral Degree.Claims technician vs. Information management specialist
An information management specialist is responsible for maintaining the security benchmark of all databases across the organization to support business functions and client requirements. Information management specialists sort and file data on the network systems and pull up reports from the storage database. They also analyze project management plans and utilize data tools to identify solutions and collect critical information. An information management specialist handles data management system troubleshooting and provide resolution reports to avoid downtime reoccurrence.
Types of claims technician
Updated January 8, 2025
