Analyst, Claims Job Description

Analyst, Claims Job Description

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Analyst, claims provides guidance related to ICD-10-CM, ICD-9-CM, CPT, HCPCS coding systems.

Analyst, Claims Duties & Responsibilities

To write an effective analyst, claims job description, begin by listing detailed duties, responsibilities and expectations. We have included analyst, claims job description templates that you can modify and use.

Sample responsibilities for this position include:

Conduct all phases of the audit
Evaluate accuracy and effectiveness of Operations administration of benefits on all claim systems and lines of business
Conduct trend analysis
Assist with/support Government Programs enterprise-wide projects
Participate in internal/external meetings
Train, coach, and serve as a resource for junior staff members
Work with Managers to collaborate with business and project leaders to recommend, implement, track, and report on financial process improvements
Assist in developing discipline-specific financial models for use in long- and short-term business planning, projects and analysis
Monitors all payroll claims activity and is the primary liaison for claims processing support
Collaborates with a team of SMEs along with various workstreams to resolve Employee inquiries/cases within the SLA timeframe

Analyst, Claims Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Analyst, Claims

List any licenses or certifications required by the position: CCS, SCLA, AIC, ITIL, B2, ASE, BA, PB, CIA, THIT

Education for Analyst, Claims

Typically a job would require a certain level of education.

Employers hiring for the analyst, claims job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Business, Education, Finance, Accounting, Business/Administration, Associates, Management, Communications, Technical, Law

Skills for Analyst, Claims

Desired skills for analyst, claims include:

ICD-9
Coding and billing processes
ICD-10 and HCPCS coding
Excel
Pricing
Code of Federal Regulations
Common Law Liability
National Motor Freight Classification system
Programming languages
Risk reduction and claims process

Desired experience for analyst, claims includes:

Handling phone enquiries promptly and within service standards
Communicating regularly with claimants on the status of their claim
Writing clear and concise correspondence to all applicable parties
Ability to communicate effectively, both verbally and in writing, and interact successfully with clients, external supplies, third parties, personnel and management
Familiar with the Intercompany Arbitration agreement
Ability to function effectively in fast paced multi-faceted environment

Analyst, Claims Examples

1

Analyst, Claims Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of analyst, claims. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for analyst, claims
  • Assists with quality data testing, regression testing, or as assigned
  • Collectively collaborates with a team of payroll SMEs to proactively monitor internal controls to ensure accuracy, compliance, and timely execution of activity that could impact the system claims functionality
  • Verify and update information related to data entry, submitted claims, authorizations and workflow processes to determine reimbursement eligibility
  • Ensure payments/denials are processed in accordance with Provider contracts, authorizations, the company's New York policies and procedures and in compliance with NY State and CMS policies and regulations
  • Analyze claims and report billing discrepancies for overpayments, retroactive termination errors, duplicate billing/payments, and coding errors
  • Make sure Providers are in compliance with billing guidelines
  • Clarify health insurance coverage regarding claims’ processing
  • Maintain records, files, and documentation as appropriate
  • Meet department production and quality standards
  • Assist with administrative and operation activities
Qualifications for analyst, claims
  • Ability to interpret residential policy wordings
  • Superior time management skills in order to successfully manage a large number of pending files
  • CIP designation or workings towards
  • Previous Claims exposure
  • Operational business unit familiarity is preferred
  • Ability to work having a high degree of accuracy
2

Analyst, Claims Job Description

Job Description Example
Our company is growing rapidly and is looking for an analyst, claims. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for analyst, claims
  • Close cooperation and coordination with Shared Services regarding Proportional Claim Events and Cash Losses, coordination of combined payments
  • Process FSA/QME/PRA claims
  • Review submitted claim forms and documentation for accuracy and completion
  • Requests additional information as needed, utilizing system-generated correspondence
  • Enter new claims for payment
  • Handle administrative processes related to claims
  • Assists with month end reports
  • Serve as peer mentor to associates, reviews work of Associates
  • Coordinate and manage cyclical Health & Welfare maintenance letters and all administrative steps associated with the processes
  • Assist the service center and client teams with resolving participant issues, concerns and inquiries
Qualifications for analyst, claims
  • Fully bilingual (French/ English) an asset
  • Support the development of business cases including benefits identification, RFI/RFP and service level agreements with vendors/suppliers consistent with technology
  • Proficient in French is an asset
  • Must have or be actively working toward LOMA or ICA courses in order to obtain the FLMI, ALHC or FLHC designations
  • Bachelor's Degree or pending Degree in a Technical area of study including Finance, Mathematics, Industrial Engineering preferred
  • Intern work experience or be able to describe real-world application of data and analysis projects from school
3

Analyst, Claims Job Description

Job Description Example
Our innovative and growing company is hiring for an analyst, claims. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for analyst, claims
  • Identifies deficiencies and potential penalty situations and communicate to stakeholders
  • Presents audit results to management
  • Recommends training and improvement activities needed to meet established operational, technical audit and state requirements
  • Field claims and assess the damages/values of claims
  • Analyze and settle claims for incidents that occurred during moving process for residential and/or commercial clients
  • Draft and process settlement claims
  • Develop management reports detailing the review process findings trending/analysis reports
  • Perform research to identify cost of individual claim items such as, taxes, liens or property maintenance
  • Analyze account disbursements of escrow and corporate advances while adhering to investor guidelines for fund reconciliation
  • Process reimbursement claims to investors, often utilizing accounting skills to balance non-performing loans
Qualifications for analyst, claims
  • Understanding of health plan and managed care operations
  • Strong communication and interpersonal skills to be able to interact with all levels within the organization, including executives
  • Ability to develop reports and pull data individually or be able to develop comprehensive specifications to present to DSS for ad-hoc report requests
  • Expertise in the development and implementation of work flow processes using the Image Silo application
  • Experience with EDI solutions, Edifecs
  • Requires a technical, business, or scientific Bachelors’ Degree
4

Analyst, Claims Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of analyst, claims. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for analyst, claims
  • To analyse claims data to identify incorrect costs and to devise methods for controlling or eliminating them
  • To assess and pre-authorise high cost repairs
  • In assessing claims, check for valid parts and labour usage and, where necessary take up any anomalies with the depot staff, involving more senior people where necessary
  • Processing of any Customer Parts warranty claims received at Depot level
  • Evaluate new and ongoing claims to determine liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence
  • Investigate questionable claims
  • Determine need for additional medical information
  • Perform periodic follow-ups to verify continued existence of a disabling condition
  • Respond to telephone and written inquiries from Claimants, Attorneys, Physicians and Policy Holders
  • Update and maintain accurate records on electronic processing system
Qualifications for analyst, claims
  • Knowledge of CPT, ICD, RBRVS, and other applicable references
  • Demonstrated knowledge of both mainframe and personal computer programs
  • Mortgage industry background would be ideal but not required
  • Experience working in corporate setting in reverse logistics field is preferred
  • Must have strong work ethics and ability to complete task on time
  • Must be self-motivated and be able to work under pressure in fast paced environment
5

Analyst, Claims Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of analyst, claims. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for analyst, claims
  • Contributing directly in client and/or broker visits, finalist sales presentations, and implementation and renewal meetings
  • Participating in weekly or bi-weekly customer service calls with Brokers and Account Managers
  • Initiating referrals to various resources including linked waiver of premium, special investigations unit, appeals, settlement, life assistance program, employee assistance program
  • Discussing ongoing contract issues with clients and Account Managers when they arise
  • Supplying clients with various reports upon request
  • Consulting with Account Managers regarding policy trends or changes, and collaborating to create special handling guidelines on accounts
  • Ensuring that all governmental, provincial, contractual, and corporate guidelines are met throughout the life of the claims
  • Ongoing training in the areas of medical, financial, fraud, and policies and procedures
  • Familiarizing with client expectations and anticipating their needs
  • Communicating and documenting processes related to sensitive policy holders
Qualifications for analyst, claims
  • Required - Knowledge of Perot / Peradigm system
  • Preferred - Knowledge of Legacy and Intelliclaim systems / processes
  • Knowledge of JM&A systems preferred
  • Ability and willingness to work overtime, Saturdays and holidays as needed
  • CPCU, ARM, or ACM designation
  • Minimum three years in claims management

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