Insurance processor vs medical claims processor

The differences between insurance 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 processor and a medical claims processor. Additionally, a medical claims processor has an average salary of $36,777, which is higher than the $33,041 average annual salary of an insurance processor.

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

Insurance processor vs medical claims processor overview

	Insurance Processor	Medical Claims Processor
Yearly salary	$33,041	$36,777
Hourly rate	$15.89	$17.68
Growth rate	-3%	-3%
Number of jobs	50,523	59,992
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 33%	Bachelor's Degree, 29%
Average age	44	44
Years of experience	4	4

What does an insurance processor do?

Insurance Processors deal with the processing of insurance applications, amendments of policies, changes, and cancellations. An Insurance Processor works with the client to choose the best insurance package and advise them on how to maximize their benefits. Clients need to understand the insurance process by answering inquiries. It is also essential that an Insurance Processor work hand in hand with the client, guiding them through the process, explaining all crucial parts of the insurance to establish trust in you and the company.

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 processor vs medical claims processor salary

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

	Insurance Processor	Medical Claims Processor
Average salary	$33,041	$36,777
Salary range	Between $28,000 And $38,000	Between $29,000 And $45,000
Highest paying City	Leawood, KS	Dover, DE
Highest paying state	Connecticut	Delaware
Best paying company	Moore County Hospital District	Cognizant
Best paying industry	Finance	Government

Differences between insurance processor and medical claims processor education

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

	Insurance Processor	Medical Claims Processor
Most common degree	Bachelor's Degree, 33%	Bachelor's Degree, 29%
Most common major	Business	Business
Most common college	-	-

Insurance processor vs medical claims processor demographics

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

	Insurance Processor	Medical Claims Processor
Average age	44	44
Gender ratio	Male, 16.3% Female, 83.7%	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 processor and medical claims processor duties and responsibilities

Insurance processor example responsibilities.

Manage database by processing renewals and endorsements.
Input and process all dental claims, through electronic and paper submission, to private insurance companies and Medicaid.
Maintain patient privacy and confidentiality complaint with HIPPA regulations.
Work directly with mortgage lenders and foreclosure attorneys to negotiate timely and cost effective repayment plans or modifications for delinquent loans.
Handle a substantial amount of Allstate customers, third party carriers, and others who need assistance to file a claim.

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 processor vs medical claims processor skills

Common insurance processor skills

Data Entry, 18%
Customer Service, 12%
Phone Calls, 9%
Outbound Calls, 9%
Insurance Claims, 6%
Insurance Coverage, 5%

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 Processor vs Medical Claims Processor

Updated January 8, 2025

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