What does a Claims Administrator do?
Claims administrators are professionals who are responsible for performing administrative duties related to insurance claims. These administrators must collaborate with insurance companies so that they can analyze claims and determine the extent of the company's liability. They must review billing and process claims correctly by identifying provider information and other documentation to ensure a prompt payout. Claims administrators must also maintain and manage the compensation files of all workers in order to conduct preliminary investigations on work-related injuries for worker's compensation claims.
Claims administrator responsibilities
Here are examples of responsibilities from real claims administrator resumes:
- Manage adding and removing vendors through claims automate system to ensure they are in compliance with IRS regulations.
- Implement HIPAA regulations to protect patient privacy.
- Adjudicate medical, commercial and Medicaid, claims.
- Code medical records by following current ICD-9/ICD-10, CPT, and HCPCS standards.
- Work with doctors, TPA, adjusters, attorneys, to maintain claim cost effectively.
- Process various compensation benefits applications for veterans in compliance with organizational laws, federal laws, rules and regulations.
- Audit claims to ensure the claim procedures are correct base on GEICO's regulations and payments are accurate.
Claims administrator skills and personality traits
We calculated that 12% of Claims Administrators are proficient in Data Entry, Customer Service, and Process Claims. They’re also known for soft skills such as Analytical skills, Detail oriented, and Math skills.
We break down the percentage of Claims Administrators that have these skills listed on their resume here:
- Data Entry, 12%
Scheduled and trained all operators for Customer Service Representation and data entry support.
- Customer Service, 9%
Analyzed policies and processes with regard to customer service efficiency and recommended changes to account managers for improvements as necessary.
- Process Claims, 8%
Process claims for security and non security in accordance with court-approved plan of allocation, and settlement stipulation
- Phone Calls, 7%
Answer phone calls in a fast paced environment; respond to questions and requests; referring inquiries to the pharmacists.
- HR, 5%
Reorganized HR tracking of required information.
- Insurance Claims, 5%
Required to review and processed medical documentation for payment processing for various insurance claims.
Common skills that a claims administrator uses to do their job include "data entry," "customer service," and "process claims." You can find details on the most important claims administrator responsibilities below.
Math skills. Another skill that relates to the job responsibilities of claims administrators is math skills. This skill is critical to many everyday claims administrator duties, as "the job duties of financial clerks includes calculating charges and updating financial records." This example from a resume shows how this skill is used: "coded dental claims for reimbursable payments to doctors and insurance carriers cut weekly checks, and maintained reports and statistics. "
Organizational skills. A big part of what claims administrators do relies on "organizational skills." You can see how essential it is to claims administrator responsibilities because "financial clerks must be able to arrange files so they can find them quickly and efficiently." Here's an example of how this skill is used from a resume that represents typical claims administrator tasks: "handled all policies and procedures based on organizational polices, state regulations and hippa. "
Communication skills. Another crucial skill for a claims administrator to carry out their responsibilities is "communication skills." A big part of what claims administrators relies on this skill, since "financial clerks should be able to explain policies and procedures to colleagues and customers." How this skill relates to claims administrator duties can be seen in an example from a claims administrator resume snippet: "strengthened beneficial business alliances by providing quality communication and customer service to patients, practitioners, and manufacturers. "
The three companies that hire the most claims administrators are:
- 2-108 claims administrators jobs
- Risk Strategies3 claims administrators jobs
- Cambro Manufacturing2 claims administrators jobs
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Compare different claims administrators
Claims administrator vs. Insurance clerk
An insurance clerk usually works to process insurance, reinstatement, changes, or cancellations for a company or an individual account. They are responsible for monitoring, processing, and organizing different insurance claims for a client. They usually work closely with the company's insurance agent to provide necessary information to process the clients' application. This career requires a broad knowledge of local and state insurance policies, good attention to detail, excellent communication skills, customer service skills, and administrative skills.
These skill sets are where the common ground ends though. The responsibilities of a claims administrator are more likely to require skills like "process claims," "phone calls," "hr," and "insurance claims." On the other hand, a job as an insurance clerk requires skills like "patients," "insurance verification," "insurance coverage," and "patient accounts." As you can see, what employees do in each career varies considerably.
Insurance clerks tend to make the most money working in the finance industry, where they earn an average salary of $33,939. In contrast, claims administrators make the biggest average salary, $37,214, in the hospitality industry.The education levels that insurance clerks earn slightly differ from claims administrators. In particular, insurance clerks are 2.0% less likely to graduate with a Master's Degree than a claims administrator. Additionally, they're 1.4% less likely to earn a Doctoral Degree.Claims administrator vs. Insurance specialist
An insurance specialist is an individual responsible for interpreting insurance plans and providing risk management advice to clients and wealth managers. Insurance specialists must have a full understanding of risk management to craft a comprehensive solution that integrates well with the client's portfolio. They need to manage their clients' accounts and should maintain contact with clients after the application process. Insurance specialists must ensure that government insurance programs comply with federal laws, regulations, and contracts within the healthcare industry.
In addition to the difference in salary, there are some other key differences worth noting. For example, claims administrator responsibilities are more likely to require skills like "process claims," "phone calls," "hr," and "claims management." Meanwhile, an insurance specialist has duties that require skills in areas such as "patients," "exceptional client," "insurance coverage," and "insurance verification." These differences highlight just how different the day-to-day in each role looks.
Insurance specialists may earn a lower salary than claims administrators, but insurance specialists earn the most pay in the government industry with an average salary of $38,343. On the other hand, claims administrators receive higher pay in the hospitality industry, where they earn an average salary of $37,214.Average education levels between the two professions vary. Insurance specialists tend to reach similar levels of education than claims administrators. In fact, they're 0.1% more likely to graduate with a Master's Degree and 1.4% less likely to earn a Doctoral Degree.Claims administrator vs. Insurance verifier
An insurance verifier specializes in dealing with the billing process and patient claims. As the process begins, insurance verifiers look into patient insurance information and verify treatments that their policies cover. They call the insurance companies and send proper documentation to verify pre-approval for the required procedure. Eventually, the insurance verifiers work with insurance companies to bill them for the procedure. Their tasks may also include communicating with patients about benefits, coverage, and care authorization, and liaising with patients and providers to communicate their needs and current state.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a claims administrator is likely to be skilled in "process claims," "phone calls," "hr," and "claims management," while a typical insurance verifier is skilled in "patients," "insurance verification," "insurance eligibility," and "health insurance."
Insurance verifiers typically earn similar educational levels compared to claims administrators. Specifically, they're 3.0% less likely to graduate with a Master's Degree, and 1.7% less likely to earn a Doctoral Degree.Claims administrator vs. Insurance biller
An insurance biller is responsible for making daily reviews and processing documents concerning the insurance payment and bills of a client. They assess if all requirements are correct and complete, obtain different referrals and authorization papers, and prepare and transmit document claims using a particular software. Also, they do follow ups regarding unpaid claims and update spreadsheets for record purposes.
Types of claims administrator
Updated January 8, 2025
