Business Analyst - Claims Process

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.

What responsibilities are common for Claims Analyst jobs?

- 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.