Senior claims examiner vs claims adjudicator

The differences between senior claims examiners and claims adjudicators 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 examiner and a claims adjudicator. Additionally, a senior claims examiner has an average salary of $50,962, which is higher than the $44,556 average annual salary of a claims adjudicator.

The top three skills for a senior claims examiner include customer service, litigation and property damage. The most important skills for a claims adjudicator are medical terminology, CPT, and disability claims.

Senior claims examiner vs claims adjudicator overview

	Senior Claims Examiner	Claims Adjudicator
Yearly salary	$50,962	$44,556
Hourly rate	$24.50	$21.42
Growth rate	-6%	-6%
Number of jobs	10,931	12,413
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 58%	Bachelor's Degree, 57%
Average age	44	44
Years of experience	6	6

What does a senior claims examiner do?

Senior claims examiners review, assess, and process the insurance claims of their clients. The examiners provide recommendations for claims-related resolution. It is their responsibility to examine and authorize the investigation of insurance claims as conducted by insurance adjusters. They check the claims and the insurance policies to ensure that all the information is right. During the settlement, they are expected to be careful in keeping the records with details of the process.

What does a claims adjudicator do?

Claims adjudicators determine the amount of money an insurance policy owner is entitled to receive. Other names they are known for are claims adjusters and medical bill advocates. They investigate the claims filed and decide to deny, pay, or negotiate a settlement with the policyholder themselves or their representatives. The insurance companies that hire them provide insurances for property, casualty, and liability. To do their job well, they should be organized and understand how the insurance industry works.

Senior claims examiner vs claims adjudicator salary

Senior claims examiners and claims adjudicators have different pay scales, as shown below.

	Senior Claims Examiner	Claims Adjudicator
Average salary	$50,962	$44,556
Salary range	Between $34,000 And $75,000	Between $31,000 And $63,000
Highest paying City	Urban Honolulu, HI	Madison, WI
Highest paying state	Hawaii	New Jersey
Best paying company	W. R. Berkley	Evolent Health
Best paying industry	Finance	Insurance

Differences between senior claims examiner and claims adjudicator education

There are a few differences between a senior claims examiner and a claims adjudicator in terms of educational background:

	Senior Claims Examiner	Claims Adjudicator
Most common degree	Bachelor's Degree, 58%	Bachelor's Degree, 57%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Senior claims examiner vs claims adjudicator demographics

Here are the differences between senior claims examiners' and claims adjudicators' demographics:

	Senior Claims Examiner	Claims Adjudicator
Average age	44	44
Gender ratio	Male, 29.6% Female, 70.4%	Male, 23.1% Female, 76.9%
Race ratio	Black or African American, 10.8% Unknown, 4.4% Hispanic or Latino, 16.8% Asian, 5.2% White, 62.3% American Indian and Alaska Native, 0.5%	Black or African American, 10.5% Unknown, 4.5% Hispanic or Latino, 15.3% Asian, 6.1% White, 63.0% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between senior claims examiner and claims adjudicator duties and responsibilities

Senior claims examiner example responsibilities.

Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
Coordinate vendor referrals for additional investigation and/or litigation management
Maintain office records of various types of complaints, conciliation, administrative decision, private litigation resolution, gather detailed information.
Ensure all HIPPA regulations are followed in the creation and release of all confidential records.
Coordinate vendor referrals for additional investigation and/or litigation management

Claims adjudicator example responsibilities.

Manage appeals and authorizations by examining information and performing necessary adjustments.
Handle claims processing utilizing knowledge of medical coding standards, including HCPCS, CPT, and ICD-9.
Calculate refunds or credit balances involving reprocessing for partial adjustments and correct the CPT and ICD-9 codes.
Maintain compliance with HIPAA guidelines and regulations
Adjudicate claims for Medicaid, Medicare, and ambulance billing.
Interpret and processes routine and complex claims per Medicaid industry standards.

Senior claims examiner vs claims adjudicator skills

Common senior claims examiner skills

Customer Service, 21%
Litigation, 11%
Property Damage, 9%
Claims Handling, 6%
TPA, 4%
Coverage Issues, 4%

Common claims adjudicator skills

Medical Terminology, 9%
CPT, 8%
Disability Claims, 7%
Adjudicate Claims, 6%
Quality Standards, 6%
Medicaid, 5%

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Senior Claims Examiner
Senior Claims Examiner vs Claims Adjudicator

Updated January 8, 2025

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