Senior claims specialist vs claims benefit specialist

The differences between senior claims specialists 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 specialist and a claims benefit specialist. Additionally, a senior claims specialist has an average salary of $69,808, which is higher than the $47,292 average annual salary of a claims benefit specialist.

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

Senior claims specialist vs claims benefit specialist overview

	Senior Claims Specialist	Claims Benefit Specialist
Yearly salary	$69,808	$47,292
Hourly rate	$33.56	$22.74
Growth rate	-6%	-6%
Number of jobs	11,011	32,208
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 65%	Bachelor's Degree, 40%
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 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 specialist vs claims benefit specialist salary

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

	Senior Claims Specialist	Claims Benefit Specialist
Average salary	$69,808	$47,292
Salary range	Between $45,000 And $107,000	Between $32,000 And $68,000
Highest paying City	-	-
Highest paying state	-	-
Best paying company	-	-
Best paying industry	-	-

Differences between senior claims specialist and claims benefit specialist education

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

	Senior Claims Specialist	Claims Benefit Specialist
Most common degree	Bachelor's Degree, 65%	Bachelor's Degree, 40%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Senior claims specialist vs claims benefit specialist demographics

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

	Senior Claims Specialist	Claims Benefit Specialist
Average age	44	44
Gender ratio	Male, 40.7% Female, 59.3%	Male, 19.6% Female, 80.4%
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, 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 specialist and claims benefit specialist 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 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 specialist vs claims benefit specialist skills

Common senior claims specialist skills

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

Updated January 8, 2025

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