Claim Analyst

Job Description

The Claims Analyst (CA) is primarily responsible for meeting production and quality expectations. The CA will be responsible for auditing claims while working independently to identify and secure payer refunds. The CA will also be responsible for the identification and development of new trend ideas and will work closely with the analytics team.

Role Qualifications

  • Proficiency with MS Office Suite including Excel, Word, and Outlook
  • Knowledge of MS Access/SQL/relational databases a plus.
  • Excellent communications, presentation, time/project management, problem solving, organizational, and analytical skills required.
  • Working knowledge of Medicare, Medicaid and Commercial Insurance plans

Position responsibilities

  • Manage claims review within specific area
  • Access system and verify validity of claims
  • Understand and interpret policy regarding claims
  • Creating database information for tracking purposes
  • Review for reasonableness of tests, procedures and hospital stays
  • Other duties as assigned

Skills and Experience

  • 3+ years experience in a healthcare operations preferred
  • 4-year college degree preferred or equivalent
  • Superior verbal and written communication skills
  • Superb interpersonal and relationship-building skills
  • Exceptional organizational and problem-solving skills
  • Ability to work independently in an efficient and responsible manner
  • Team player with history of successful goal attainment

Demands and work environment

The demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Other demands may, from time to time, be required.

  • Physical demands: While performing the duties of this job, the employee is regularly required to sit, stand, walk; use hands and fingers to handle, or feel objects, tools, or controls; reach with hands and arms; balance; stoop; talk or hear. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Frequent travel for this position may be required.
  • Mental demands: While performing the duties of this job, the employee is regularly required to understand and follow oral/written instruction, guide and or give instruction, and make decisions in accordance with established procedures and policies.
  • Work Environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time. Travel is determined based on workload.

To apply to this position please send your resume to and reference the position: Claims Analyst.

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