Medical claims analyst vs claims adjudicator

The differences between medical claims analysts and claims adjudicators can be seen in a few details. Each job has different responsibilities and duties. It typically takes 4-6 years to become both a medical claims analyst and a claims adjudicator. Additionally, a medical claims analyst has an average salary of $46,708, which is higher than the $44,556 average annual salary of a claims adjudicator.

The top three skills for a medical claims analyst include medical terminology, medicaid and medical insurance claims. The most important skills for a claims adjudicator are medical terminology, CPT, and disability claims.

Medical claims analyst vs claims adjudicator overview

	Medical Claims Analyst	Claims Adjudicator
Yearly salary	$46,708	$44,556
Hourly rate	$22.46	$21.42
Growth rate	-6%	-6%
Number of jobs	65,897	12,413
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 57%
Average age	44	44
Years of experience	6	6

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 a claims adjudicator do?

Claims adjudicators determine the amount of money an insurance policy owner is entitled to receive. Other names they are known for are claims adjusters and medical bill advocates. They investigate the claims filed and decide to deny, pay, or negotiate a settlement with the policyholder themselves or their representatives. The insurance companies that hire them provide insurances for property, casualty, and liability. To do their job well, they should be organized and understand how the insurance industry works.

Medical claims analyst vs claims adjudicator salary

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

	Medical Claims Analyst	Claims Adjudicator
Average salary	$46,708	$44,556
Salary range	Between $32,000 And $68,000	Between $31,000 And $63,000
Highest paying City	Bridgewater, NJ	Madison, WI
Highest paying state	New Jersey	New Jersey
Best paying company	Montefiore Mount Vernon Hospital	Evolent Health
Best paying industry	Insurance	Insurance

Differences between medical claims analyst and claims adjudicator education

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

	Medical Claims Analyst	Claims Adjudicator
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 57%
Most common major	Business	Business
Most common college	University of Pennsylvania	Stanford University

Medical claims analyst vs claims adjudicator demographics

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

	Medical Claims Analyst	Claims Adjudicator
Average age	44	44
Gender ratio	Male, 14.2% Female, 85.8%	Male, 23.1% Female, 76.9%
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, 10.5% Unknown, 4.5% Hispanic or Latino, 15.3% Asian, 6.1% White, 63.0% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between medical claims analyst and claims adjudicator 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.

Claims adjudicator example responsibilities.

Manage appeals and authorizations by examining information and performing necessary adjustments.
Handle claims processing utilizing knowledge of medical coding standards, including HCPCS, CPT, and ICD-9.
Calculate refunds or credit balances involving reprocessing for partial adjustments and correct the CPT and ICD-9 codes.
Maintain compliance with HIPAA guidelines and regulations
Adjudicate claims for Medicaid, Medicare, and ambulance billing.
Interpret and processes routine and complex claims per Medicaid industry standards.

Medical claims analyst vs claims adjudicator skills

Common medical claims analyst skills

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

Common claims adjudicator skills

Medical Terminology, 9%
CPT, 8%
Disability Claims, 7%
Adjudicate Claims, 6%
Quality Standards, 6%
Medicaid, 5%

Medical Claims Analyst vs. similar jobs

Medical Claims Analyst related careers

Medical Claims Analyst related jobs

What similar roles do

Zippia Careers
Business and Financial Industry
Medical Claims Analyst
Medical Claims Analyst vs Claims Adjudicator

Updated January 8, 2025

Browse business and financial jobs