Senior claims analyst vs claims representative

The differences between senior claims analysts and claims representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 4-6 years to become both a senior claims analyst and a claims representative. Additionally, a senior claims analyst has an average salary of $79,886, which is higher than the $38,796 average annual salary of a claims representative.

The top three skills for a senior claims analyst include customer service, litigation and medical terminology. The most important skills for a claims representative are customer service, quality standards, and policy coverage.

Senior claims analyst vs claims representative overview

	Senior Claims Analyst	Claims Representative
Yearly salary	$79,886	$38,796
Hourly rate	$38.41	$18.65
Growth rate	-6%	-6%
Number of jobs	21,159	18,565
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 61%	Bachelor's Degree, 62%
Average age	44	44
Years of experience	6	6

What does a senior claims analyst do?

Senior Claims Analysts are responsible for providing support and oversight on the process of liability claims. Their duties include verifying submitted claims, assessing reimbursement policies, performing reconciliation with claims estimates, and conducting payment negotiations. They manage claims processing costs, prepare payment documents, reclassify entries, and attend to requestors' queries. Senior Claims Analyst also organizes records and assist in providing mentorship and training sessions to junior staff.

What does a claims representative do?

A Claims Representative is an agent who works for insurance companies in order to investigate and settle claims. The agent acts as an intermediary between customers and insurance companies by evaluating the customers' facts surrounding claims and determining whether the loss is covered or should be compensated. Such a role is important because an agent makes sure that no fraud claims are being paid out. It is also highlighted that an agent works in compliance with state regulations.

Senior claims analyst vs claims representative salary

Senior claims analysts and claims representatives have different pay scales, as shown below.

	Senior Claims Analyst	Claims Representative
Average salary	$79,886	$38,796
Salary range	Between $52,000 And $122,000	Between $28,000 And $53,000
Highest paying City	San Leandro, CA	Dearborn, MI
Highest paying state	Hawaii	New Jersey
Best paying company	Alameda Health System	W. R. Berkley
Best paying industry	Finance	Government

Differences between senior claims analyst and claims representative education

There are a few differences between a senior claims analyst and a claims representative in terms of educational background:

	Senior Claims Analyst	Claims Representative
Most common degree	Bachelor's Degree, 61%	Bachelor's Degree, 62%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Senior claims analyst vs claims representative demographics

Here are the differences between senior claims analysts' and claims representatives' demographics:

	Senior Claims Analyst	Claims Representative
Average age	44	44
Gender ratio	Male, 30.8% Female, 69.2%	Male, 37.5% Female, 62.5%
Race ratio	Black or African American, 11.3% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 62.0% American Indian and Alaska Native, 0.5%	Black or African American, 11.0% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between senior claims analyst and claims representative duties and responsibilities

Senior claims analyst example responsibilities.

Accomplish facets and Macess user including running reports.
Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
Coordinate the maintenance of TPA payment type / code table conversions data.
Process claims, generate checks, create reports and correspond with TPA clients.
Review claims for correct billing information such as correct CPT codes, ICD code and patient information.
Analyze, evaluate, and conduct statistical data reviews as required by CMS in accordance with ZPIC policies.

Claims representative example responsibilities.

Perform initial set-up and continuously manage claims in the Juris claims management system.
Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
Prepare necessary state filings within statutory limits, manage litigation and vocational rehabilitation process, used appropriate cost containment techniques.
Assist the training department in developing CSR training in order to set expectations.
Create custom templates and guide sheets for new trainees in the CSR Internet division to ensure consistency and increase department efficiency.
Utilize proper SIU reporting procedures for extensive investigation as required.

Senior claims analyst vs claims representative skills

Common senior claims analyst skills

Customer Service, 7%
Litigation, 7%
Medical Terminology, 6%
Coverage Issues, 6%
Policy Provisions, 5%
Medicaid, 5%

Common claims representative skills

Customer Service, 26%
Quality Standards, 6%
Policy Coverage, 6%
Reservations, 5%
Claims Handling, 3%
Insurance Coverage, 3%

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Senior Claims Analyst
Senior Claims Analyst vs Claims Representative

Updated January 8, 2025

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