Insurance claims processor vs medical claims processor

The differences between insurance claims processors and medical claims processors 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 medical claims processor. Additionally, an insurance claims processor has an average salary of $37,151, which is higher than the $36,777 average annual salary of a medical claims processor.

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

Insurance claims processor vs medical claims processor overview

	Insurance Claims Processor	Medical Claims Processor
Yearly salary	$37,151	$36,777
Hourly rate	$17.86	$17.68
Growth rate	-3%	-3%
Number of jobs	48,777	59,992
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 30%	Bachelor's Degree, 29%
Average age	44	44
Years of experience	4	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 a medical claims processor do?

A medical claims processor has working knowledge of medical billing and coding. The qualifications for this position include knowledge of current procedural terminology (CPT) and international classification of diseases (ICD) coding systems. They are responsible for processing claims forms, adjudicating the allocation of deductibles and copays, and following through with adjudication policies to facilitate proper payment of claims.

Insurance claims processor vs medical claims processor salary

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

	Insurance Claims Processor	Medical Claims Processor
Average salary	$37,151	$36,777
Salary range	Between $30,000 And $45,000	Between $29,000 And $45,000
Highest paying City	Eden Prairie, MN	Dover, DE
Highest paying state	Connecticut	Delaware
Best paying company	Accenture	Cognizant
Best paying industry	Insurance	Government

Differences between insurance claims processor and medical claims processor education

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

	Insurance Claims Processor	Medical Claims Processor
Most common degree	Bachelor's Degree, 30%	Bachelor's Degree, 29%
Most common major	Business	Business
Most common college	-	-

Insurance claims processor vs medical claims processor demographics

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

	Insurance Claims Processor	Medical Claims Processor
Average age	44	44
Gender ratio	Male, 20.3% Female, 79.7%	Male, 16.0% Female, 84.0%
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, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%
LGBT Percentage	11%	11%

Differences between insurance claims processor and medical claims 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.

Medical claims processor example responsibilities.

Enter UB 92 and 1500 HCFA medical claims into computer system manage and process insurance claims.
Manage cases by aggressively directing the litigation process.
Submit medical claims to commercial insurance companies, Medicare, and Medicaid for payment with use of ICD-9 and CPT coding.
Review and verify patient account information against insurance program specifications, analyze surgical procedures and diagnoses using CPT-4 and ICD-9 codes.
Acknowledge and enforces confidentiality in alignment with (HIPPA) guidelines.
Audit encounters and ICD-10 codes to ensure correct coding and maximum reimbursement.

Insurance claims processor vs medical claims 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 medical claims processor skills

Patients, 13%
Healthcare, 10%
Data Entry, 10%
Medical Insurance Claims, 9%
Medical Terminology, 6%
Customer Service, 3%

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Insurance Claims Processor vs Medical Claims Processor

Updated January 8, 2025

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