Senior claims specialist vs claims adjudicator

The differences between senior claims specialists 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 specialist and a claims adjudicator. Additionally, a senior claims specialist has an average salary of $69,808, which is higher than the $44,556 average annual salary of a claims adjudicator.

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

Senior claims specialist vs claims adjudicator overview

	Senior Claims Specialist	Claims Adjudicator
Yearly salary	$69,808	$44,556
Hourly rate	$33.56	$21.42
Growth rate	-6%	-6%
Number of jobs	11,011	12,413
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 65%	Bachelor's Degree, 57%
Average age	44	44
Years of experience	6	6

What does a senior claims specialist do?

A senior claims specialist's role is to handle and process insurance claims, ensuring accuracy and smooth workflow. Their responsibilities include liaising with clients to identify their needs, reviewing and validating documentation, resolving issues and concerns, and traveling to different locations in order to perform claims inspections and investigations for client eligibility. They may also approve claims applications and negotiate settlements. Furthermore, as a senior claims specialist, it is essential to lead and serve as a mentor to junior specialists, all while implementing the company's policies and regulations.

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 specialist vs claims adjudicator salary

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

	Senior Claims Specialist	Claims Adjudicator
Average salary	$69,808	$44,556
Salary range	Between $45,000 And $107,000	Between $31,000 And $63,000
Highest paying City	-	Madison, WI
Highest paying state	-	New Jersey
Best paying company	-	Evolent Health
Best paying industry	-	Insurance

Differences between senior claims specialist and claims adjudicator education

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

	Senior Claims Specialist	Claims Adjudicator
Most common degree	Bachelor's Degree, 65%	Bachelor's Degree, 57%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Senior claims specialist vs claims adjudicator demographics

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

	Senior Claims Specialist	Claims Adjudicator
Average age	44	44
Gender ratio	Male, 40.7% Female, 59.3%	Male, 23.1% Female, 76.9%
Race ratio	Black or African American, 12.0% Unknown, 4.4% Hispanic or Latino, 16.8% Asian, 5.2% White, 61.0% 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 specialist and claims adjudicator duties and responsibilities

Senior claims specialist example responsibilities.

Manage assigned third party administration (TPA) multi-jurisdictional workers' compensation; subrogation recovery claims; assign defense attorney.
Work toward settlement with claimants and attorneys, or determine company litigation strategy, participating in mediation and arbitration when necessary.
Maintain EDI processing table logic.
Work with testing HIPAA transactions, reporting and processing data reporting to the state.
Review data entry of claims receive through the EDI system for accuracy prior to processing.
Operate within all company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.

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 specialist vs claims adjudicator skills

Common senior claims specialist skills

Customer Service, 26%
Litigation, 10%
Claims Handling, 8%
SR, 5%
Settlement Conferences, 5%
Excellent Interpersonal, 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 Specialist
Senior Claims Specialist vs Claims Adjudicator

Updated January 8, 2025

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