Senior claims examiner vs claims benefit specialist

The differences between senior claims examiners and claims benefit specialists 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 benefit specialist. Additionally, a senior claims examiner has an average salary of $50,962, which is higher than the $47,292 average annual salary of a claims benefit specialist.

The top three skills for a senior claims examiner include customer service, litigation and property damage. The most important skills for a claims benefit specialist are customer inquiries, appeals, and medical terminology.

Senior claims examiner vs claims benefit specialist overview

	Senior Claims Examiner	Claims Benefit Specialist
Yearly salary	$50,962	$47,292
Hourly rate	$24.50	$22.74
Growth rate	-6%	-6%
Number of jobs	10,931	32,208
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 58%	Bachelor's Degree, 40%
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 benefit specialist do?

Claims and benefits specialists ensure their company's compliance with the internal and external health plan partner processes. The job requires them to be sharp, organized, and able to multitask. They recommend strategies that will improve the processes present in the current trends that they constantly evaluate. These specialists manage portfolios of claims and benefits issues and ensure that they provide the best resolutions that follow the health plan processing guidelines to impress their clients.

Senior claims examiner vs claims benefit specialist salary

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

	Senior Claims Examiner	Claims Benefit Specialist
Average salary	$50,962	$47,292
Salary range	Between $34,000 And $75,000	Between $32,000 And $68,000
Highest paying City	Urban Honolulu, HI	-
Highest paying state	Hawaii	-
Best paying company	W. R. Berkley	-
Best paying industry	Finance	-

Differences between senior claims examiner and claims benefit specialist education

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

	Senior Claims Examiner	Claims Benefit Specialist
Most common degree	Bachelor's Degree, 58%	Bachelor's Degree, 40%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Senior claims examiner vs claims benefit specialist demographics

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

	Senior Claims Examiner	Claims Benefit Specialist
Average age	44	44
Gender ratio	Male, 29.6% Female, 70.4%	Male, 19.6% Female, 80.4%
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, 11.4% Unknown, 4.4% Hispanic or Latino, 16.9% Asian, 5.2% White, 61.6% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between senior claims examiner and claims benefit specialist 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 benefit specialist example responsibilities.

Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
Analyze each claim and calculate percentages for both PPO and NON-PPO providers.
Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines
Process Non-HMO and PPO paper and electronic claims in an accurate and time manner.

Senior claims examiner vs claims benefit specialist skills

Common senior claims examiner skills

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

Common claims benefit specialist skills

Customer Inquiries, 11%
Appeals, 7%
Medical Terminology, 6%
Routine Claims, 5%
CPT, 4%
Processing Issues, 4%

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Senior Claims Examiner
Senior Claims Examiner vs Claims Benefit Specialist

Updated January 8, 2025

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