Insurance claims processor vs insurance verification specialist

The differences between insurance claims processors and insurance verification specialists 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 $33,043 average annual salary of an insurance verification specialist.

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

Insurance claims processor vs insurance verification specialist overview

	Insurance Claims Processor	Insurance Verification Specialist
Yearly salary	$37,151	$33,043
Hourly rate	$17.86	$15.89
Growth rate	-3%	6%
Number of jobs	48,777	71,688
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 30%	Associate Degree, 27%
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 verification specialist do?

An insurance verification specialist is responsible for confirming a patient's insurance details and eligibility to receive medical care services. Insurance verification specialists review the insurance documents of the patients, including its coverage and limitations, and escalate concerns to the supervisor for immediate resolution. They process paperwork accordingly upon coordinating with the patients and attending health professionals. An insurance verification specialist must have excellent communication and organizational skills, finishing administrative tasks efficiently under minimal supervision.

Insurance claims processor vs insurance verification specialist salary

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

	Insurance Claims Processor	Insurance Verification Specialist
Average salary	$37,151	$33,043
Salary range	Between $30,000 And $45,000	Between $28,000 And $37,000
Highest paying City	Eden Prairie, MN	Madison, WI
Highest paying state	Connecticut	New Hampshire
Best paying company	Accenture	St. Luke's Cataract & Laser Institute
Best paying industry	Insurance	Pharmaceutical

Differences between insurance claims processor and insurance verification specialist education

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

	Insurance Claims Processor	Insurance Verification Specialist
Most common degree	Bachelor's Degree, 30%	Associate Degree, 27%
Most common major	Business	Health Care Administration
Most common college	-	University of Pennsylvania

Insurance claims processor vs insurance verification specialist demographics

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

	Insurance Claims Processor	Insurance Verification Specialist
Average age	44	46
Gender ratio	Male, 20.3% Female, 79.7%	Male, 11.4% Female, 88.6%
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, 9.3% Unknown, 3.6% Hispanic or Latino, 16.0% Asian, 4.9% White, 66.1% American Indian and Alaska Native, 0.1%
LGBT Percentage	11%	7%

Differences between insurance claims processor and insurance verification specialist 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 verification specialist example responsibilities.

Check CPT and ICD-10 codes with LCD and policies from multiple insurance companies to make sure procedures will be paid.
Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records.
Confirm correct charges base on HCPCS codes.
Assist callers as well with questions about their benefits, terms and conditions of medical plans, appeals and grievances.
Provide medical record support in the absence of EMR: assist clinics and hospitals in obtaining medical records in appropriate format.
Document outbound communication from providers and veterans.

Insurance claims processor vs insurance verification specialist 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 verification specialist skills

Patients, 25%
Insurance Verification, 15%
Customer Service, 7%
Insurance Eligibility, 5%
Data Entry, 4%
Medical Terminology, 4%

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Insurance Claims Processor
Insurance Claims Processor vs Insurance Verification Specialist

Updated January 8, 2025

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