Insurance claims processor vs claim processor

The differences between insurance claims processors and claim processors can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 2-4 years to become an insurance claims processor, 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 $37,151 average annual salary of an insurance claims processor.

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

Insurance claims processor vs claim processor overview

	Insurance Claims Processor	Claim Processor
Yearly salary	$37,151	$41,201
Hourly rate	$17.86	$19.81
Growth rate	-3%	-6%
Number of jobs	48,777	11,542
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 30%	Bachelor's Degree, 43%
Average age	44	44
Years of experience	4	6

What does an insurance claims processor do?

A claims processor usually works in health or property insurance claims. They are responsible for processing and evaluating the claim forms, monitoring and verifying information, and closely communicating with the company's clients, beneficiaries, and agents. Also, they handle queries and comments, calculate possible claims, and process of various payments. They also need to ensure all insurance company guidelines and policies are adhered to in order to avoid discrepancies, issues, and other problems regarding a client's claims.

What does a claim processor do?

A Claims Processor is responsible for processing and verifying insurance claims, in adherence to the policies, laws, and regulations of the company involved. Aside from examining its authenticity, they must also oversee new policies and recommend modifications should it be needed. Moreover, it is also the task of the Claims Processor to prepare the necessary documents and guidelines for the policyholder, process reimbursements upon approval, provide answers to inquiries, and report issues and updates to the management.

Insurance claims processor vs claim processor salary

Insurance claims processors and claim processors have different pay scales, as shown below.

	Insurance Claims Processor	Claim Processor
Average salary	$37,151	$41,201
Salary range	Between $30,000 And $45,000	Between $26,000 And $62,000
Highest paying City	Eden Prairie, MN	Columbia, MD
Highest paying state	Connecticut	Connecticut
Best paying company	Accenture	NTT Data International L.L.C.
Best paying industry	Insurance	Insurance

Differences between insurance claims processor and claim processor education

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

	Insurance Claims Processor	Claim Processor
Most common degree	Bachelor's Degree, 30%	Bachelor's Degree, 43%
Most common major	Business	Business
Most common college	-	Stanford University

Insurance claims processor vs claim processor demographics

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

	Insurance Claims Processor	Claim Processor
Average age	44	44
Gender ratio	Male, 20.3% Female, 79.7%	Male, 22.9% Female, 77.1%
Race ratio	Black or African American, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%	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	11%	10%

Differences between insurance claims processor and claim processor duties and responsibilities

Insurance claims processor example responsibilities.

Manage cases by aggressively directing the litigation process.
Maintain confidentiality in accordance with HIPAA laws.
Process ICD-9 codes, diagnostic and procedure codes.
Handle confidential information according to HIPPA and JAACHO standards.
Follow and comply with HIPPA rules and regulations to ensure patient privacy.
Process medical and dental claims using appropriate CPT, ICD-9, and ADA coding.

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.

Insurance claims processor vs claim processor skills

Common insurance claims processor skills

Data Entry, 18%
Customer Service, 11%
Medicaid, 8%
Medical Terminology, 6%
Insurance Coverage, 5%
ICD-9, 4%

Common claim processor skills

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

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Insurance Claims Processor
Insurance Claims Processor vs Claim Processor

Updated January 8, 2025

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