Insurance follow up representative vs medical claims processor

The differences between insurance follow up representatives and medical claims processors can be seen in a few details. Each job has different responsibilities and duties. Additionally, a medical claims processor has an average salary of $36,777, which is higher than the $33,022 average annual salary of an insurance follow up representative.

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

Insurance follow up representative vs medical claims processor overview

	Insurance Follow Up Representative	Medical Claims Processor
Yearly salary	$33,022	$36,777
Hourly rate	$15.88	$17.68
Growth rate	6%	-3%
Number of jobs	57,034	59,992
Job satisfaction	5	-
Most common degree	Associate Degree, 28%	Bachelor's Degree, 29%
Average age	46	44
Years of experience	-	4

What does an insurance follow up representative do?

Insurance Follow Up Representatives are responsible for processing and bringing claim resolution to outstanding medical insurance accounts for a healthcare organization. Their duties include managing status account updates, assessing the course of action for accounts, conducting outbound calls, handling incoming calls, and processing correspondences with relevant parties involved. They also perform reconciliation, issue escalation to team leaders, and ensure compliance with company policies and regulations.

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 follow up representative vs medical claims processor salary

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

	Insurance Follow Up Representative	Medical Claims Processor
Average salary	$33,022	$36,777
Salary range	Between $26,000 And $41,000	Between $29,000 And $45,000
Highest paying City	-	Dover, DE
Highest paying state	-	Delaware
Best paying company	-	Cognizant
Best paying industry	-	Government

Differences between insurance follow up representative and medical claims processor education

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

	Insurance Follow Up Representative	Medical Claims Processor
Most common degree	Associate Degree, 28%	Bachelor's Degree, 29%
Most common major	Health Care Administration	Business
Most common college	University of Pennsylvania	-

Insurance follow up representative vs medical claims processor demographics

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

	Insurance Follow Up Representative	Medical Claims Processor
Average age	46	44
Gender ratio	Male, 11.3% Female, 88.7%	Male, 16.0% Female, 84.0%
Race ratio	Black or African American, 9.2% Unknown, 3.6% Hispanic or Latino, 15.7% Asian, 4.8% White, 66.5% American Indian and Alaska Native, 0.1%	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	7%	11%

Differences between insurance follow up representative and medical claims processor duties and responsibilities

Insurance follow up representative example responsibilities.

Conduct analysis/research and lead dispute resolutions in appeals processes.
Cold-Cal to generate leads for individual life and disability insurance and annuities.
Network with various patient accounts financial officers of several medical centers and hospitals to certify uninsure patients for Medicaid.
Study ICD-9 and ICD-10 to gain further knowledge of the new changes coming within the coding.
Maintain all HIPPA rules, regulations and guidelines.
Apply all HIPPA rules and regulations to all accounts.

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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.

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Insurance follow up representative vs medical claims processor skills

Common insurance follow up representative skills

Patients, 17%
Customer Service, 10%
Medical Billing, 7%
Patient Accounts, 7%
Phone Calls, 6%
Appeals, 6%

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 Follow Up Representative
Insurance Follow Up Representative vs Medical Claims Processor

Updated January 8, 2025

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