Medical claims examiner vs liability claims representative

The differences between medical claims examiners and liability claims representatives 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 examiner and a liability claims representative. Additionally, a liability claims representative has an average salary of $45,654, which is higher than the $42,773 average annual salary of a medical claims examiner.

The top three skills for a medical claims examiner include medical terminology, customer service and data entry. The most important skills for a liability claims representative are litigation, claims handling, and customer service.

Medical claims examiner vs liability claims representative overview

	Medical Claims Examiner	Liability Claims Representative
Yearly salary	$42,773	$45,654
Hourly rate	$20.56	$21.95
Growth rate	-6%	-6%
Number of jobs	57,125	13,563
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 81%
Average age	44	44
Years of experience	6	6

What does a medical claims examiner do?

A medical claims examiner determines whether an insurer will be covering losses from accidents and illness. They are responsible for evaluating insurance claims and applications, following up with insurance adjusters to protect an insurer from financial loss, ensuring information integrity, and ensuring standard guidelines are adhered to. They are also tasked with approving payment and facilitating additional investigation. Qualifications for this position include knowledge of medical terminology.

What does a liability claims representative do?

A liability claims representative works at insurance companies where they are in charge of processing and settling insurance claims, ensuring accurate and efficient client service. They are responsible for conducting assessments, reviewing reports from examiners, and tracking any discrepancies such as underpayment or overpayment, reporting them right away. There are also times when they must meet with clients and inspect damages, conduct interviews and evaluations, estimate and negotiate settlements with external parties, and coordinate with other professionals to gain insights. Moreover, a liability claims representative maintains an active communication line with staff, resolving issues in a timely manner.

Medical claims examiner vs liability claims representative salary

Medical claims examiners and liability claims representatives have different pay scales, as shown below.

	Medical Claims Examiner	Liability Claims Representative
Average salary	$42,773	$45,654
Salary range	Between $30,000 And $59,000	Between $33,000 And $61,000
Highest paying City	Los Angeles, CA	Somerville, MA
Highest paying state	New Jersey	New Jersey
Best paying company	UST Global	The Travelers Companies
Best paying industry	Technology	Insurance

Differences between medical claims examiner and liability claims representative education

There are a few differences between a medical claims examiner and a liability claims representative in terms of educational background:

	Medical Claims Examiner	Liability Claims Representative
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 81%
Most common major	Business	Business
Most common college	University of Pennsylvania	Stanford University

Medical claims examiner vs liability claims representative demographics

Here are the differences between medical claims examiners' and liability claims representatives' demographics:

	Medical Claims Examiner	Liability Claims Representative
Average age	44	44
Gender ratio	Male, 16.6% Female, 83.4%	Male, 43.1% Female, 56.9%
Race ratio	Black or African American, 10.5% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 62.4% American Indian and Alaska Native, 0.5%	Black or African American, 11.5% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 61.7% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between medical claims examiner and liability claims representative duties and responsibilities

Medical claims examiner example responsibilities.

Manage cases by aggressively directing the litigation process.
Process medical facility claims payment according to account-specific contract (HMO, PPO, EPO, etc . )
Process PPO, HMO, comprehensive plans, including medicare supplements, hospital, chiropractic and physical therapy claims.
Identify which claims are eligible for PPO reprising.
Resolve medical claims by approving and/or denying base on CMS guidelines for Medicaid/Medicare claim processing.
Verify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.

Liability claims representative example responsibilities.

Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
Investigate and conclude property and casualty liability claims including those in litigation with the highest overall production of the claims representatives.
Participate in arbitration hearings through writing contentions, compiling evidence and personally representing files.
Control expenses by developing and following resolutions and/or litigation plans to drive claim to resolution.
Facilitate training seminars for new employees to familiarize them with various corporate procedures including exposure recognition, fraud detection and arbitration.
Complete field inspection of losses including accurate scope of damages, photographic evidence collection, written estimates utilizing Xactimate estimating software.

Medical claims examiner vs liability claims representative skills

Common medical claims examiner skills

Medical Terminology, 10%
Customer Service, 9%
Data Entry, 7%
Medical Treatment, 5%
Computer System, 5%
Provider Contracts, 4%

Common liability claims representative skills

Litigation, 9%
Claims Handling, 8%
Customer Service, 7%
Law Enforcement Agencies, 6%
Insurance Claims, 6%
Reservations, 6%

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Medical Claims Examiner
Medical Claims Examiner vs Liability Claims Representative

Updated January 8, 2025

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