What does a Claims Analyst do?
Claims analysts process insurance claims and monitor records involving these claims. They compile and analyze claims-associated data and perform related duties including tracking trends, noting patterns, and watching to detect any irregularities. They may perform or oversee investigations to validate the legitimacy of claims or verify the accuracy of invoiced amounts. These analysts often serve as a liaison between numerous internal departments, including customer service, accounts payable, legal, and others.
Claims analysts typically have an associate or bachelor’s degree, although some employers are willing to accept an equivalent amount of professional experience in the insurance field. These positions require excellent computer skills, including familiarity with claims processing programs and accounting or record-keeping software. These professionals must also have strong data analytics skills, and experience interpreting legal contracts is also helpful.
- Handle property claims, limited in scope, based on claims guidelines.
- Research, create, and maintain all reimbursement related information and data to ensure regulatory compliance.
- Follow all policies and procedures established for the department.
- Answer client/patient questions to ensure understanding and client/patient satisfaction, or refers them to more senior level staff.
- Analyze and process claims in accordance with plan provisions.
- Develop and maintain strong business relationships with internal and external customers.
- Manage reserve adjustments and payments to avoid deficit payments.
- Maintain compliance with claim routing and inventory control procedures.
- Oversee advanced claim inquiries and assist claims staff with responding appropriately as needed.
- Calculate monthly contractual allowances, post journal entries, and explain variances to budget and prior periods.
- Document, track and resolve all plan providers' claims projects.
- Adhere to all statutory and regulatory fair claims practices.
- Assist in the maintenance of the guidelines for the processing of specialty accident and health insurance claims.
- Associate's or Bachelor's Degree in business, accounting, or computer science.
- Excellent command of English language.
- Proficiency with Microsoft Office Suite, particularly Excel.
- Requires careful attention to detail.
- Strong problem-solving and time management skills.
- Advanced understanding of HIPAA regulations and commitment to protecting patient/client privacy.
- Able to multitask and prioritize.
How much does a Claims Analyst make?
Claims Analyst Career Path
Learn how to become a Claims Analyst, what skills and education you need to succeed, and what level of pay to expect at each step on your career path.
Average Years of Experience
Claims Analyst Insights
“The pay is better than what I had been getting in my previous line of work.”
“While working at this place I was not happy and my mental health suffered from having un realistic deadlines and work load.”
“I had a little girl in 2021 and HR was wonderful to work with in helping me get organized and prepped for my leave.”
“They provide professional and personal development.”
“I have been with Kemper over 10 years and feel very fortunate to have my career here.”
“Was a good place to work and got to work from home”
“Management picks and chooses and gives better things to friends”
“Demoted one of the best supervisors in our department because she focused on our quality not the other metrics.”
Claims Analyst Interviews
Frequently asked questions about the roles and responsibilities of a Claims Analyst
- Claims Adjuster
- Claims Examiner
- Claims Processor
- Claims Manager