Medical claims processor vs claims administrator

The differences between medical claims processors and claims administrators can be seen in a few details. Each job has different responsibilities and duties. It typically takes 2-4 years to become both a medical claims processor and a claims administrator. Additionally, a medical claims processor has an average salary of $36,777, which is higher than the $36,432 average annual salary of a claims administrator.

The top three skills for a medical claims processor include patients, healthcare and data entry. The most important skills for a claims administrator are data entry, customer service, and process claims.

Medical claims processor vs claims administrator overview

	Medical Claims Processor	Claims Administrator
Yearly salary	$36,777	$36,432
Hourly rate	$17.68	$17.52
Growth rate	-3%	-3%
Number of jobs	59,992	59,006
Job satisfaction	-	4
Most common degree	Bachelor's Degree, 29%	Bachelor's Degree, 53%
Average age	44	44
Years of experience	4	4

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.

What does a claims administrator do?

Claims administrators are professionals who are responsible for performing administrative duties related to insurance claims. These administrators must collaborate with insurance companies so that they can analyze claims and determine the extent of the company's liability. They must review billing and process claims correctly by identifying provider information and other documentation to ensure a prompt payout. Claims administrators must also maintain and manage the compensation files of all workers in order to conduct preliminary investigations on work-related injuries for worker's compensation claims.

Medical claims processor vs claims administrator salary

Medical claims processors and claims administrators have different pay scales, as shown below.

	Medical Claims Processor	Claims Administrator
Average salary	$36,777	$36,432
Salary range	Between $29,000 And $45,000	Between $29,000 And $44,000
Highest paying City	Dover, DE	Reno, NV
Highest paying state	Delaware	Connecticut
Best paying company	Cognizant	ABB
Best paying industry	Government	Hospitality

Differences between medical claims processor and claims administrator education

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

	Medical Claims Processor	Claims Administrator
Most common degree	Bachelor's Degree, 29%	Bachelor's Degree, 53%
Most common major	Business	Business
Most common college	-	-

Medical claims processor vs claims administrator demographics

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

	Medical Claims Processor	Claims Administrator
Average age	44	44
Gender ratio	Male, 16.0% Female, 84.0%	Male, 28.9% Female, 71.1%
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 medical claims processor and claims administrator duties and responsibilities

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.

Claims administrator example responsibilities.

Manage adding and removing vendors through claims automate system to ensure they are in compliance with IRS regulations.
Implement HIPAA regulations to protect patient privacy.
Adjudicate medical, commercial and Medicaid, claims.
Code medical records by following current ICD-9/ICD-10, CPT, and HCPCS standards.
Work with doctors, TPA, adjusters, attorneys, to maintain claim cost effectively.
Process various compensation benefits applications for veterans in compliance with organizational laws, federal laws, rules and regulations.

Medical claims processor vs claims administrator skills

Common medical claims processor skills

Patients, 13%
Healthcare, 10%
Data Entry, 10%
Medical Insurance Claims, 9%
Medical Terminology, 6%
Customer Service, 3%

Common claims administrator skills

Data Entry, 12%
Customer Service, 9%
Process Claims, 8%
Phone Calls, 7%
HR, 5%
Insurance Claims, 5%

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Medical Claims Processor
Medical Claims Processor vs Claims Administrator

Updated January 8, 2025

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