Insurance claims processor vs insurance representative

The differences between insurance claims processors and insurance representatives can be seen in a few details. Each job has different responsibilities and duties. Additionally, an insurance claims processor has an average salary of $37,151, which is higher than the $35,958 average annual salary of an insurance representative.

The top three skills for an insurance claims processor include data entry, customer service and medicaid. The most important skills for an insurance representative are customer service, patients, and health insurance.

Insurance claims processor vs insurance representative overview

	Insurance Claims Processor	Insurance Representative
Yearly salary	$37,151	$35,958
Hourly rate	$17.86	$17.29
Growth rate	-3%	6%
Number of jobs	48,777	87,843
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 30%	Bachelor's Degree, 45%
Average age	44	46
Years of experience	4	-

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 an insurance representative do?

An insurance representative serves as a client's point of contact in insurance companies. Their responsibilities include researching client opportunities, reaching out to potential clients to offer products and services, discussing terms and policies, providing detailed advice, and assisting in every procedure, ensuring convenience and client satisfaction. Aside from securing sales, an insurance representative may also process applications and claims while adhering to the company's policies and regulations. Furthermore, they may also perform clerical tasks such as handling calls and correspondence, arranging appointments, and maintaining records of all transactions.

Insurance claims processor vs insurance representative salary

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

	Insurance Claims Processor	Insurance Representative
Average salary	$37,151	$35,958
Salary range	Between $30,000 And $45,000	Between $29,000 And $44,000
Highest paying City	Eden Prairie, MN	Lacey, WA
Highest paying state	Connecticut	Washington
Best paying company	Accenture	Santander Bank
Best paying industry	Insurance	Finance

Differences between insurance claims processor and insurance representative education

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

	Insurance Claims Processor	Insurance Representative
Most common degree	Bachelor's Degree, 30%	Bachelor's Degree, 45%
Most common major	Business	Business
Most common college	-	University of Pennsylvania

Insurance claims processor vs insurance representative demographics

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

	Insurance Claims Processor	Insurance Representative
Average age	44	46
Gender ratio	Male, 20.3% Female, 79.7%	Male, 29.8% Female, 70.2%
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, 9.4% Unknown, 3.6% Hispanic or Latino, 16.1% Asian, 4.9% White, 65.9% American Indian and Alaska Native, 0.1%
LGBT Percentage	11%	7%

Differences between insurance claims processor and insurance representative 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.

Insurance representative example responsibilities.

Cold-Cal to generate leads for individual life and disability insurance and annuities.
Confer with AAA members to discuss options and plans for the insurance needs of family and services provide.
Promote AAA insurance to current, former, and potentially new customers by providing quality and accurate product knowledge.
Assist field agents with Medicare applications, review Medicaid state system regarding eligibility.
Review medical web sites and Medicare inquiry system to determine eligibility for Medicaid and other insurance policies.
Facilitate communications between doctors, hospitals, third party insurance companies and patients to obtain and verify patient billing information.

Insurance claims processor vs insurance representative skills

Common insurance claims processor skills

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

Common insurance representative skills

Customer Service, 18%
Patients, 16%
Health Insurance, 6%
Medicaid, 4%
Insurance Coverage, 4%
Data Entry, 4%

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Insurance Claims Processor
Insurance Claims Processor vs Insurance Representative

Updated January 8, 2025

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