Medical claims processor vs claims clerk

The differences between medical claims processors and claims clerks 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 clerk. Additionally, a medical claims processor has an average salary of $36,777, which is higher than the $32,815 average annual salary of a claims clerk.

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

Medical claims processor vs claims clerk overview

	Medical Claims Processor	Claims Clerk
Yearly salary	$36,777	$32,815
Hourly rate	$17.68	$15.78
Growth rate	-3%	-3%
Number of jobs	59,992	78,588
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 29%	Bachelor's Degree, 31%
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 clerk do?

Claims clerks review the forms and documents for insurance claims to check for missing information and attachments. The data they obtain is entered into their database for safekeeping and quick retrieval. They should know the answers to their clients' questions about the regulations, policies, and procedures covered by their insurance policy. These clerks prepare documents that their agents use to present to their clients. When working for this position, a person must have the ability to communicate well and be familiar with computer applications.

Medical claims processor vs claims clerk salary

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

	Medical Claims Processor	Claims Clerk
Average salary	$36,777	$32,815
Salary range	Between $29,000 And $45,000	Between $27,000 And $39,000
Highest paying City	Dover, DE	-
Highest paying state	Delaware	-
Best paying company	Cognizant	-
Best paying industry	Government	-

Differences between medical claims processor and claims clerk education

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

	Medical Claims Processor	Claims Clerk
Most common degree	Bachelor's Degree, 29%	Bachelor's Degree, 31%
Most common major	Business	Business
Most common college	-	-

Medical claims processor vs claims clerk demographics

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

	Medical Claims Processor	Claims Clerk
Average age	44	44
Gender ratio	Male, 16.0% Female, 84.0%	Male, 17.5% Female, 82.5%
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 clerk 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 clerk example responsibilities.

Manage adding and removing vendors through claims automate system to ensure they are in compliance with IRS regulations.
File commercial, worker's comp, Medicare, and Medicaid claims to insurance carriers and employers.
Open and sort mail by claim types (HCPA UB 92 and T18).
Process medical HMO claims, POS claims, PPO claims and fee for service claims.
Review, scan, and file HCFA forms
Audit paper claims for accuracy in CPT and ICD9 codes.

Medical claims processor vs claims clerk 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 clerk skills

Data Entry, 26%
Customer Service, 9%
Clerical Support, 7%
Computer System, 5%
Medical Claims, 4%
Process Claims, 4%

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Medical Claims Processor
Medical Claims Processor vs Claims Clerk

Updated January 8, 2025

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