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Insurance claims processor vs claims clerk

The differences between insurance claims processors and claims clerks can be seen in a few details. Each job has different responsibilities and duties. It typically takes 2-4 years to become both an insurance claims processor and a claims clerk. Additionally, an insurance claims processor has an average salary of $37,151, which is higher than the $32,815 average annual salary of a claims clerk.

The top three skills for an insurance claims processor include data entry, customer service and medicaid. The most important skills for a claims clerk are data entry, customer service, and clerical support.

Insurance claims processor vs claims clerk overview

Insurance Claims ProcessorClaims Clerk
Yearly salary$37,151$32,815
Hourly rate$17.86$15.78
Growth rate-3%-3%
Number of jobs48,77778,588
Job satisfaction--
Most common degreeBachelor's Degree, 30%Bachelor's Degree, 31%
Average age4444
Years of experience44

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 claims clerk do?

Claims clerks review the forms and documents for insurance claims to check for missing information and attachments. The data they obtain is entered into their database for safekeeping and quick retrieval. They should know the answers to their clients' questions about the regulations, policies, and procedures covered by their insurance policy. These clerks prepare documents that their agents use to present to their clients. When working for this position, a person must have the ability to communicate well and be familiar with computer applications.

Insurance claims processor vs claims clerk salary

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

Insurance Claims ProcessorClaims Clerk
Average salary$37,151$32,815
Salary rangeBetween $30,000 And $45,000Between $27,000 And $39,000
Highest paying CityEden Prairie, MN-
Highest paying stateConnecticut-
Best paying companyAccenture-
Best paying industryInsurance-

Differences between insurance claims processor and claims clerk education

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

Insurance Claims ProcessorClaims Clerk
Most common degreeBachelor's Degree, 30%Bachelor's Degree, 31%
Most common majorBusinessBusiness
Most common college--

Insurance claims processor vs claims clerk demographics

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

Insurance Claims ProcessorClaims Clerk
Average age4444
Gender ratioMale, 20.3% Female, 79.7%Male, 17.5% Female, 82.5%
Race ratioBlack 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, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%
LGBT Percentage11%11%

Differences between insurance claims processor and claims clerk 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.
    • Show more

Claims clerk example responsibilities.

  • Manage adding and removing vendors through claims automate system to ensure they are in compliance with IRS regulations.
  • File commercial, worker's comp, Medicare, and Medicaid claims to insurance carriers and employers.
  • Open and sort mail by claim types (HCPA UB 92 and T18).
  • Process medical HMO claims, POS claims, PPO claims and fee for service claims.
  • Review, scan, and file HCFA forms
  • Audit paper claims for accuracy in CPT and ICD9 codes.
    • Show more

Insurance claims processor vs claims clerk skills

Common insurance claims processor skills
  • Data Entry, 18%
  • Customer Service, 11%
  • Medicaid, 8%
  • Medical Terminology, 6%
  • Insurance Coverage, 5%
  • ICD-9, 4%
Common claims clerk skills
  • Data Entry, 26%
  • Customer Service, 9%
  • Clerical Support, 7%
  • Computer System, 5%
  • Medical Claims, 4%
  • Process Claims, 4%

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Updated January 8, 2025

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