Insurance claims processor vs claims manager

The differences between insurance claims processors and claims managers 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 claims manager takes usually requires 4-6 years. Additionally, a claims manager has an average salary of $73,369, 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 claims manager are customer service, oversight, and litigation.

Insurance claims processor vs claims manager overview

	Insurance Claims Processor	Claims Manager
Yearly salary	$37,151	$73,369
Hourly rate	$17.86	$35.27
Growth rate	-3%	-6%
Number of jobs	48,777	30,302
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 30%	Bachelor's Degree, 66%
Average age	44	47
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 claims manager do?

A claims manager is an individual who works in an insurance-based firm and is responsible for managing the insurance claims department that is composed of examiners and adjusters. Claims managers are required to maintain claim files and reviewing these files as well as communicate with customers to follow up regarding issues they face with insurance claims. They must determine who is liable for the damage if there were other parties involved. Claims managers must also include an expert to assess the amount of damage and avoid insurance fraud.

Insurance claims processor vs claims manager salary

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

	Insurance Claims Processor	Claims Manager
Average salary	$37,151	$73,369
Salary range	Between $30,000 And $45,000	Between $45,000 And $117,000
Highest paying City	Eden Prairie, MN	San Francisco, CA
Highest paying state	Connecticut	California
Best paying company	Accenture	Zurich
Best paying industry	Insurance	Insurance

Differences between insurance claims processor and claims manager education

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

	Insurance Claims Processor	Claims Manager
Most common degree	Bachelor's Degree, 30%	Bachelor's Degree, 66%
Most common major	Business	Business
Most common college	-	California State University - Bakersfield

Insurance claims processor vs claims manager demographics

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

	Insurance Claims Processor	Claims Manager
Average age	44	47
Gender ratio	Male, 20.3% Female, 79.7%	Male, 47.9% Female, 52.1%
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, 10.0% Unknown, 4.8% Hispanic or Latino, 17.1% Asian, 5.9% White, 61.5% American Indian and Alaska Native, 0.7%
LGBT Percentage	11%	8%

Differences between insurance claims processor and claims manager 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.

Claims manager example responsibilities.

Manage multiple outsource PPO networks that enable company to increase top line revenue.
Achieve improved structure and efficiency with initiation of pip specific unit.
Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
Oversee implementation and management of litigation and expense protocols including AFA agreements and BLO oversight.
Respond to all DOI questions and concerns.
Work with TPA, service providers and personnel on the design, implementation, and management of wellness programs.

Insurance claims processor vs claims manager 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 manager skills

Customer Service, 15%
Oversight, 11%
Litigation, 8%
Direct Reports, 4%
Claims Handling, 4%
Insurance Claims, 3%

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Insurance Claims Processor
Insurance Claims Processor vs Claims Manager

Updated January 8, 2025

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