Medical claims processor vs insurance clerk

The differences between medical claims processors and insurance 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 an insurance clerk. Additionally, a medical claims processor has an average salary of $36,777, which is higher than the $33,089 average annual salary of an insurance clerk.

The top three skills for a medical claims processor include patients, healthcare and data entry. The most important skills for an insurance clerk are patients, insurance verification, and data entry.

Medical claims processor vs insurance clerk overview

	Medical Claims Processor	Insurance Clerk
Yearly salary	$36,777	$33,089
Hourly rate	$17.68	$15.91
Growth rate	-3%	-3%
Number of jobs	59,992	147,755
Job satisfaction	-	2
Most common degree	Bachelor's Degree, 29%	High School Diploma, 29%
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 an insurance clerk do?

An insurance clerk usually works to process insurance, reinstatement, changes, or cancellations for a company or an individual account. They are responsible for monitoring, processing, and organizing different insurance claims for a client. They usually work closely with the company's insurance agent to provide necessary information to process the clients' application. This career requires a broad knowledge of local and state insurance policies, good attention to detail, excellent communication skills, customer service skills, and administrative skills.

Medical claims processor vs insurance clerk salary

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

	Medical Claims Processor	Insurance Clerk
Average salary	$36,777	$33,089
Salary range	Between $29,000 And $45,000	Between $27,000 And $39,000
Highest paying City	Dover, DE	Henderson, NV
Highest paying state	Delaware	New Hampshire
Best paying company	Cognizant	Lenoir Memorial Hospital
Best paying industry	Government	Finance

Differences between medical claims processor and insurance clerk education

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

	Medical Claims Processor	Insurance Clerk
Most common degree	Bachelor's Degree, 29%	High School Diploma, 29%
Most common major	Business	Business
Most common college	-	-

Medical claims processor vs insurance clerk demographics

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

	Medical Claims Processor	Insurance Clerk
Average age	44	44
Gender ratio	Male, 16.0% Female, 84.0%	Male, 8.3% Female, 91.7%
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 insurance 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.

Insurance clerk example responsibilities.

Manage front office check-in, insurance verification and certifications from doctors.
Establish and implement procedures for completion of patient super bills with proper diagnostic coding utilizing ICD-9 and CPT code manuals.
Maintain patient medical records insuring diagnosis codes (ICD-9) are itemized correctly and name and address of insurance carriers record.
Schedule and obtain authorization for outpatient procedures for patients via private insurance, worker's compensation, and Medicare/ Medicaid.
Complete several ICD-10 training courses.
Perform medical coding with most accurate and descriptive HCPCS code.

Medical claims processor vs insurance 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 insurance clerk skills

Patients, 25%
Insurance Verification, 7%
Data Entry, 7%
Customer Service, 6%
Insurance Coverage, 5%
Computer System, 3%

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Medical Claims Processor
Medical Claims Processor vs Insurance Clerk

Updated January 8, 2025

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