Post job

Explore jobs

Find specific jobs

Explore careers

Explore professions

Best companies

Explore companies

OverviewJobsSalaryResumeSkillsWhat They DoEducationCertificationsDemographicsJob DescriptionHow To HireBest CompaniesBest StatesBest CitiesJob Outlook

Compare

Full Time jobs

Medical claims examiner vs medical claims analyst

The differences between medical claims examiners and medical claims analysts 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 medical claims analyst. Additionally, a medical claims analyst has an average salary of $46,708, 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 medical claims analyst are medical terminology, medicaid, and medical insurance claims.

Medical claims examiner vs medical claims analyst overview

Medical Claims ExaminerMedical Claims Analyst
Yearly salary$42,773$46,708
Hourly rate$20.56$22.46
Growth rate-6%-6%
Number of jobs57,12565,897
Job satisfaction5-
Most common degreeBachelor's Degree, 36%Bachelor's Degree, 36%
Average age4444
Years of experience66

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 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.

Medical claims examiner vs medical claims analyst salary

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

Medical Claims ExaminerMedical Claims Analyst
Average salary$42,773$46,708
Salary rangeBetween $30,000 And $59,000Between $32,000 And $68,000
Highest paying CityLos Angeles, CABridgewater, NJ
Highest paying stateNew JerseyNew Jersey
Best paying companyUST GlobalMontefiore Mount Vernon Hospital
Best paying industryTechnologyInsurance

Differences between medical claims examiner and medical claims analyst education

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

Medical Claims ExaminerMedical Claims Analyst
Most common degreeBachelor's Degree, 36%Bachelor's Degree, 36%
Most common majorBusinessBusiness
Most common collegeUniversity of PennsylvaniaUniversity of Pennsylvania

Medical claims examiner vs medical claims analyst demographics

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

Medical Claims ExaminerMedical Claims Analyst
Average age4444
Gender ratioMale, 16.6% Female, 83.4%Male, 14.2% Female, 85.8%
Race ratioBlack 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, 11.2% Unknown, 4.4% Hispanic or Latino, 16.4% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage10%10%

Differences between medical claims examiner and medical claims analyst 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.
    • Show more

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.
    • Show more

Medical claims examiner vs medical claims analyst 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 medical claims analyst skills
  • Medical Terminology, 9%
  • Medicaid, 6%
  • Medical Insurance Claims, 6%
  • Customer Service, 6%
  • Data Entry, 6%
  • Patients, 5%

Medical Claims Examiner vs. similar jobs

Medical Claims Examiner related careers

Medical Claims Examiner related jobs

What similar roles do

Updated January 8, 2025

Browse business and financial jobs