Health claims examiner vs senior claims representative

The differences between health claims examiners and senior claims representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 4-6 years to become both a health claims examiner and a senior claims representative. Additionally, a senior claims representative has an average salary of $54,592, which is higher than the $45,220 average annual salary of a health claims examiner.

The top three skills for a health claims examiner include medical terminology, medicaid and HMO. The most important skills for a senior claims representative are customer service, claims handling, and litigation.

Health claims examiner vs senior claims representative overview

	Health Claims Examiner	Senior Claims Representative
Yearly salary	$45,220	$54,592
Hourly rate	$21.74	$26.25
Growth rate	-6%	-6%
Number of jobs	59,641	10,995
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 75%
Average age	44	44
Years of experience	6	6

Health claims examiner vs senior claims representative salary

Health claims examiners and senior claims representatives have different pay scales, as shown below.

	Health Claims Examiner	Senior Claims Representative
Average salary	$45,220	$54,592
Salary range	Between $30,000 And $67,000	Between $31,000 And $94,000
Highest paying City	-	-
Highest paying state	-	-
Best paying company	-	-
Best paying industry	-	-

Differences between health claims examiner and senior claims representative education

There are a few differences between a health claims examiner and a senior claims representative in terms of educational background:

	Health Claims Examiner	Senior Claims Representative
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 75%
Most common major	Business	Business
Most common college	University of Pennsylvania	Stanford University

Health claims examiner vs senior claims representative demographics

Here are the differences between health claims examiners' and senior claims representatives' demographics:

	Health Claims Examiner	Senior Claims Representative
Average age	44	44
Gender ratio	Male, 17.1% Female, 82.9%	Male, 47.3% Female, 52.7%
Race ratio	Black or African American, 10.5% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 62.8% American Indian and Alaska Native, 0.5%	Black or African American, 11.2% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.3% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between health claims examiner and senior claims representative duties and responsibilities

Health claims examiner example responsibilities.

Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
Review and analyze medical claims to finalize payments according to Medicaid benefits.
Analyze and process Medicare and Medicaid claims (Primary/Secondary).
Blood collection by venipuncture and capillary technique ensure all specimens are collect accurately, on time and according to establish procedures.
Coordinate vendor referrals for additional investigation and/or litigation management

Senior claims representative example responsibilities.

Conduct detailed interviews with physicians, prepare comprehensive written reports, retain defense counsel, and effectively manage the litigation process.
Utilize Xactimate estimating system during field inspection to properly evaluate commercial property damages.
Update computer generate claim file (s) with medical diagnoses, current CPT and ICD codes.
Analyze claims using IDC and CPT coding and negotiate settlements with attorneys, claimants, medical providers, and insureds.
Set up independent medical examinations, issue denials, attend arbitration hearings.
Coordinate and attend various mediation and arbitration hearings as well as numerous settlement hearings and conferences.

Health claims examiner vs senior claims representative skills

Common health claims examiner skills

Medical Terminology, 13%
Medicaid, 11%
HMO, 10%
Data Entry, 9%
Blood Pressure, 6%
Medical Claims, 5%

Common senior claims representative skills

Customer Service, 26%
Claims Handling, 14%
Litigation, 9%
Insurance Claims, 3%
Bodily Injury Claims, 3%
Automobile Claims, 3%

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Health Claims Examiner
Health Claims Examiner vs Senior Claims Representative

Updated January 8, 2025

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