Medical claims analyst vs adjuster

The differences between medical claims analysts and adjusters can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 4-6 years to become a medical claims analyst, becoming an adjuster takes usually requires 2-4 years. Additionally, an adjuster has an average salary of $49,396, which is higher than the $46,708 average annual salary of a medical claims analyst.

The top three skills for a medical claims analyst include medical terminology, medicaid and medical insurance claims. The most important skills for an adjuster are customer service, strong customer service, and litigation.

Medical claims analyst vs adjuster overview

	Medical Claims Analyst	Adjuster
Yearly salary	$46,708	$49,396
Hourly rate	$22.46	$23.75
Growth rate	-6%	-6%
Number of jobs	65,897	7,936
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 62%
Average age	44	44
Years of experience	6	4

What does a medical claims analyst do?

A medical claims analyst audits or verifies medical claims in insurance companies. Medical claims analysts make sure that corporate reimbursement payments are accurate. Usually, they work at an office on a computer workstation. They receive Medicaid claims from specialty and medical providers for reimbursement. Their job includes the development of an enhanced procedure in handling difficult Medicare/Medicaid letters while complying with the set policies.

What does an adjuster do?

An adjuster is responsible for evaluating the extent of loss in the company by calculating the damage costs, determining the settlement payment to the client, and managing the reputation of the company for claims accountability. Adjusters must have extensive knowledge of the insurance principles and processes, following the state and federal regulations to protect clients and the business from insurance fraud. They collect documents from different organizations, perform field research, and interview witnesses to verify the accuracy of claims statement.

Medical claims analyst vs adjuster salary

Medical claims analysts and adjusters have different pay scales, as shown below.

	Medical Claims Analyst	Adjuster
Average salary	$46,708	$49,396
Salary range	Between $32,000 And $68,000	Between $35,000 And $68,000
Highest paying City	Bridgewater, NJ	Parsippany-Troy Hills, NJ
Highest paying state	New Jersey	New Jersey
Best paying company	Montefiore Mount Vernon Hospital	FCCI
Best paying industry	Insurance	Insurance

Differences between medical claims analyst and adjuster education

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

	Medical Claims Analyst	Adjuster
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 62%
Most common major	Business	Business
Most common college	University of Pennsylvania	Stanford University

Medical claims analyst vs adjuster demographics

Here are the differences between medical claims analysts' and adjusters' demographics:

	Medical Claims Analyst	Adjuster
Average age	44	44
Gender ratio	Male, 14.2% Female, 85.8%	Male, 56.9% Female, 43.1%
Race ratio	Black or African American, 11.2% Unknown, 4.4% Hispanic or Latino, 16.4% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%	Black or African American, 12.2% Unknown, 4.4% Hispanic or Latino, 16.3% Asian, 5.1% White, 61.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between medical claims analyst and adjuster duties and responsibilities

Medical claims analyst example responsibilities.

Manage cases by aggressively directing the litigation process.
Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.

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Adjuster example responsibilities.

Manage strict confidentiality of documents and comply with HIPAA regulations stipulate by the facility and government.
Review evidence obtain in liability investigations to evaluate a claim for success in recovery through litigation or arbitration.
Document measurements and relevant data to author estimates and appraisals utilizing Xactimate 28software.
Charge with answering and defending policy holders and company interests through independent and binding third-party arbitration proceedings.
Review departmental reports and financial data; prepare reports of findings, negotiating settlement demands or recommending litigation.
Prepare computerize estimates utilizing Xactimate and document all activity associate with the claim in clients web base claims management system.

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Medical claims analyst vs adjuster skills

Common medical claims analyst skills

Medical Terminology, 9%
Medicaid, 6%
Medical Insurance Claims, 6%
Customer Service, 6%
Data Entry, 6%
Patients, 5%

Common adjuster skills

Customer Service, 19%
Strong Customer Service, 7%
Litigation, 7%
Liability Claims, 6%
Policy Coverage, 6%
Insurance Claims, 4%

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Updated January 8, 2025

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