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Medical claims specialist vs insurance verification specialist

The differences between medical claims specialists and insurance verification specialists can be seen in a few details. Each job has different responsibilities and duties. Additionally, a medical claims specialist has an average salary of $35,706, which is higher than the $33,043 average annual salary of an insurance verification specialist.

The top three skills for a medical claims specialist include customer service, patients and medicaid. The most important skills for an insurance verification specialist are patients, insurance verification, and customer service.

Medical claims specialist vs insurance verification specialist overview

Medical Claims SpecialistInsurance Verification Specialist
Yearly salary$35,706$33,043
Hourly rate$17.17$15.89
Growth rate11%6%
Number of jobs82,89771,688
Job satisfaction--
Most common degreeBachelor's Degree, 38%Associate Degree, 27%
Average age4546
Years of experience12-

What does a medical claims specialist do?

A medical claims specialist is responsible for gathering and processing the information required to complete the medical insurance claims process. Typical duties include determining covered medical insurance losses, documenting medical claims actions, and resolving claims through approval or denial of documentation. In addition, you will be responsible for maintaining excellent customer service by responding to customer inquiries and following best practices. You will also be responsible for protecting company operations by maintaining the confidentiality of information.

What does an insurance verification specialist do?

An insurance verification specialist is responsible for confirming a patient's insurance details and eligibility to receive medical care services. Insurance verification specialists review the insurance documents of the patients, including its coverage and limitations, and escalate concerns to the supervisor for immediate resolution. They process paperwork accordingly upon coordinating with the patients and attending health professionals. An insurance verification specialist must have excellent communication and organizational skills, finishing administrative tasks efficiently under minimal supervision.

Medical claims specialist vs insurance verification specialist salary

Medical claims specialists and insurance verification specialists have different pay scales, as shown below.

Medical Claims SpecialistInsurance Verification Specialist
Average salary$35,706$33,043
Salary rangeBetween $28,000 And $43,000Between $28,000 And $37,000
Highest paying CityAttleboro, MAMadison, WI
Highest paying stateConnecticutNew Hampshire
Best paying companyTotal Medical Personnel StaffingSt. Luke's Cataract & Laser Institute
Best paying industryGovernmentPharmaceutical

Differences between medical claims specialist and insurance verification specialist education

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

Medical Claims SpecialistInsurance Verification Specialist
Most common degreeBachelor's Degree, 38%Associate Degree, 27%
Most common majorBusinessHealth Care Administration
Most common collegeUniversity of PennsylvaniaUniversity of Pennsylvania

Medical claims specialist vs insurance verification specialist demographics

Here are the differences between medical claims specialists' and insurance verification specialists' demographics:

Medical Claims SpecialistInsurance Verification Specialist
Average age4546
Gender ratioMale, 16.7% Female, 83.3%Male, 11.4% Female, 88.6%
Race ratioBlack or African American, 9.5% Unknown, 4.2% Hispanic or Latino, 17.0% Asian, 8.3% White, 59.8% American Indian and Alaska Native, 1.3%Black or African American, 9.3% Unknown, 3.6% Hispanic or Latino, 16.0% Asian, 4.9% White, 66.1% American Indian and Alaska Native, 0.1%
LGBT Percentage9%7%

Differences between medical claims specialist and insurance verification specialist duties and responsibilities

Medical claims specialist example responsibilities.

  • Apply Medicare, Medicaid billing guidelines to achieve maximum reimbursement.
  • Detail knowledge of medical coding; ICD-9, CPT and HCPCS codes.
  • Confirm coverage and work with private payers, commercial payers, Medicaid, and Medicare for reimbursement of provide medical services.
  • Research medical records, compliance requirements and explanations of benefits to resolve accounts payable for Medicare, Medicaid and commercial insurance.
  • Maintain strict confidentiality/privacy of patients' protect health information in accordance with HIPAA regulations.
  • Assist in educating new hires in HIPPA laws and training.
  • Show more

Insurance verification specialist example responsibilities.

  • Check CPT and ICD-10 codes with LCD and policies from multiple insurance companies to make sure procedures will be paid.
  • Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records.
  • Confirm correct charges base on HCPCS codes.
  • Assist callers as well with questions about their benefits, terms and conditions of medical plans, appeals and grievances.
  • Provide medical record support in the absence of EMR: assist clinics and hospitals in obtaining medical records in appropriate format.
  • Document outbound communication from providers and veterans.
  • Show more

Medical claims specialist vs insurance verification specialist skills

Common medical claims specialist skills
  • Customer Service, 14%
  • Patients, 9%
  • Medicaid, 7%
  • Medical Billing, 6%
  • Phone Calls, 6%
  • Medical Terminology, 5%
Common insurance verification specialist skills
  • Patients, 25%
  • Insurance Verification, 15%
  • Customer Service, 7%
  • Insurance Eligibility, 5%
  • Data Entry, 4%
  • Medical Terminology, 4%

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