Claims Analyst Job Description

Claims Analyst Job Description

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Claims analyst provides training/education on claims business processes to applicable stakeholders (e.g., claims processors, systems staff, case installation staff, process documentation team, training staff).

Claims Analyst Duties & Responsibilities

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

Sample responsibilities for this position include:

Manage client relationships by providing and updating the client on status of information needed
Responsible to participate and coordinate the delivery of projects that are generally confined department specific initiatives
Assists in the design, development, prioritizing and implementation of system updates and enhancements
Provide coaching to peers and proactively provide input to improve process and procedures
Filing of all investor/insurer claims within required guidelines to reduce exposure to curtailments and/or fines
Work with property preservation vendor, hazard claim vendor, claims outsourcing vendor, city officials, to ensure that the properties are being maintained to investor/insurer requirements
Responsible for maintaining the testing salon
Perform various analyses and audits relating to Medicaid/Medicare/Managed Care engagements
Prepare reports and may assist in presenting reports to senior management for State reporting
Perform risk assessment and audit planning

Claims Analyst Qualifications

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

Licensing or Certifications for Claims Analyst

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

Education for Claims Analyst

Typically a job would require a certain level of education.

Employers hiring for the claims analyst 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 Claims Analyst

Desired skills for claims analyst include:

PC functions in a Windows based environment
Medical terminology
Excel
Regulation E
Chargeback process
Claims case management systems
CPT
Applicable regulations
Commercial insurance policies
HMO

Desired experience for claims analyst includes:

Communicate with legal profession as required
Handling all complaints in a professional, sympathetic and timely manner
Reviewing processes to improve work flow
Strong Reporting and Research skills
5 years Property experience
Excellent negotiation skills to control, mitigate settlements and maximize recoveries

Claims Analyst Examples

1

Claims Analyst Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of claims analyst. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for claims analyst
  • Identifies drivers for these results, researches, analyzes and documents proposes corrective action
  • Coordinates special payroll runs with Payroll Supervisor to systematically support the claims process
  • Responsible for recording and monitoring the end to end claims process
  • Coordinates the collection of all authorizations, repayment agreements, and any circumstantial JE’s that evolve
  • Coordinates necessary communications and documentation for 3rd party collection agency assistance
  • Coordinates the necessary accounting entries
  • Performs detailed reconciliations with highly complex retroactivity for internal and external support
  • Creates advanced ad-hoc reporting to support internal and external functions, including detailed financial analysis and presentations
  • Researches and remains current with allowable employee deductions from pay per bargaining agreements, state and federal guidelines, employee receivable collection laws and regulations
  • Able to provide guidance and identify problematic legal issues
Qualifications for claims analyst
  • Associates degree in accounting or related business field or 3 years of relevant experience
  • Approve legitimate claims within prescribed authority limits
  • Deny or rescind claims when appropriate based on various contractual definitions, exclusions and limitations
  • Approve disability payment periods based on diagnosis, specific limitations and occupations
  • Approve Hospital benefits based on hospital stays and policy provisions
  • Abiility to excercise sound judgement in the settlement of claims
2

Claims Analyst Job Description

Job Description Example
Our company is searching for experienced candidates for the position of claims analyst. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for claims analyst
  • Obtain data on a daily, weekly & monthly basis from the relevant environments using SAS Business Intelligence tools including Enterprise Guide, SAS DI Studio, SAS Web Report Studio, Base SAS / SQL and other programming skills to enable the production of robust and insightful Management Information
  • Analyse MI data to inform the relevant stakeholders across Claims of performance, interpretting and presenting findings as appropriate
  • Continuously seek to improve the quality of MI provided to the business, and to support, prioritise, and challenge ad hoc requests from the business
  • Corresponds through verbal/written communication with policyholders, claimants, travel coordinators, to gather important information to support claim decision
  • Review, research, analysis, calculation and submission of mortgage claims
  • Interacts and communicates with agencies, investors, and insurers mid-level management, staff, and cross business units
  • Uses relevant information and independent judgment to review and file departments and others for missing information
  • May provide guidance to lower level individuals
  • Manage Workers Compensation claim activity from initial claim notice to claim conclusion
  • Review, and track all Incident Reports
Qualifications for claims analyst
  • Follow up, Organizational
  • Associates degree in Business Management or Business Administration or related degree
  • This position requires a minimum Grade 12 education plus 3 years relevant insurance experience in either Individual or Group claims, or University degree or RN qualification
  • Must be able to contribute to a positive working environment and have the ability to adapt effectively to a changing environment
  • You possess excellent verbal/written communication skills
  • You are able to obtain and maintain adjuster licensing requirements in all Atlantic Provinces, including completing necessary required CIP courses
3

Claims Analyst Job Description

Job Description Example
Our growing company is hiring for a claims analyst. 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 claims analyst
  • Ensuring marketing development Funds reimbursement
  • Ensuring all MDF claims are tracked, managed, entered, and reimbursed
  • Work with program owners and executioners to proactively track/manage the calendar of activities and associated budget
  • Work with Marketing Operations to ensure accuracy in budget reporting
  • Work with Accounting & Finance to ensure accuracy in MDF reporting
  • Review and evaluate the accuracy of the examiners’ claim decisions
  • Ensuring that all allocated wrk is handled within the Key Performance Targets
  • Conducts audits regarding the examiner and nurse's handling of medical treatment requests in accordance with utilization review guidelines and regulations
  • Reviews all internal and external changes associated with claims process to assure legal compliance with state specific regulatory guidelines
  • Administers regular compliance audits and investigates/resolves complex compliance issues
Qualifications for claims analyst
  • Experience in data acquisition and manipulation applications (MS Access, Business Objects, SAS, SQL Developer)
  • Bachelor's degree, course work in medical/dental terminology, and/or industry courses (i.e., HIAA, ICA)
  • Prior claim paying, coding, customer service, and/or medical/dental industry experience preferred
  • Bachelor’s degree in health plan management, business, accounting, computer science, or similar fields is preferred
  • 2 – 3 years of experience in an administrative support role within a managed care environment and an understanding of metrics required to support Operations divisions
  • Experience in creating reports and development of work flow processes to support operations
4

Claims Analyst Job Description

Job Description Example
Our company is searching for experienced candidates for the position of claims analyst. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims analyst
  • Billing policies and procedures
  • Responsibility for the production and distribution of reports and data sets for all lines of business
  • Monthly/Quarterly experience reports for specific clients
  • Create and analyze monthly/quarterly MI reports
  • Ability to create reports on multiple systems and with multiple applications
  • Recommend and implement systems enhancements for reporting purposes
  • Liaise with Underwriters and Financial Analysts to manage reporting expectations
  • Train and develop other team members
  • Ensure TCF functions are completed in a timely manner
  • Ensure accuracy of TCF reporting
Qualifications for claims analyst
  • Must have a comprehensive understanding of the SAP ERP functionality and downstream impacts to payroll results
  • Must be able to read payroll clusters with a deep understanding of retroactivity
  • Bachelor’s degree in business or accounting (or related field) and 5 years’ experience in Payroll
  • Must have a minimum of 3 years’ experience in SAP Payroll, Time & Benefits Module
  • Proficiency in SAP ERP modules including Payroll, Time, and Benefits modules
  • Two-year degree or experience in healthcare
5

Claims Analyst Job Description

Job Description Example
Our growing company is hiring for a claims analyst. 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 claims analyst
  • Effectively evaluating and managing Short Term Disability and Long Term Disability claims including determining eligibility and calculating the appropriate benefit amount when applicable
  • Partnering with both the customer and their physician to medically manage the claim from initial medical requests to reviewing and evaluating ongoing medical information
  • Working directly with clients and vocational coaches to facilitate a return to work either on a full time or modified duty basis
  • Providing consistent superior customer service to both our customers and clients through timely responses to all inquiries, telephone calls and e-mails while delivering on service commitments
  • Paying all covered claims accurately which includes correctly identifying and calculating offsets, cost of living adjustments, survivor benefits, residual benefits, overpayment/underpayment calculations and catastrophic disability payments
  • Accurately calculating and applying health and welfare deductions
  • Understanding and interpreting contractual language and responsibilities, and articulating this information to clients and customers
  • Accurately applying government and provincial taxes in relation to disability benefits
  • Evaluating claims to identify trends, return to work possibilities, concerns and make any necessary modifications
  • Assessing medical information and preparing a summary for review while partnering with medical resource in evaluating the claim
Qualifications for claims analyst
  • Bachelor degree (or equivalent), preferably in a quantitative discipline
  • Comfortable taking ownership for own work, identifying the need for action whilst working effectively within a team
  • Previous knowledge and experience with medical insurance processing
  • Preferred - Bachelor's Degree in a related field or equivalent directly related experience
  • Knowledge of healthcare delivery Strong functional knowledge and broad multifunctional knowledge of healthcare delivery
  • Demonstrated organizational skills with the ability to prioritize, coordinate multiple tasks, and work independently

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