TEMP***Claims Analyst Job

A claims analyst is responsible for reviewing, processing, and analyzing insurance or healthcare claims to determine their validity, identifying discrepancies, and communicating with policyholders to resolve any issues, often requiring strong data analysis skills and attention to detail to ensure accurate claim processing and compliance with regulations; they may also act as a liaison between internal departments like customer service and legal teams.

Key responsibilities of a claims analyst may include:

· Claim review and processing:

Examining submitted claims for accuracy, completeness, and eligibility against policy guidelines.

· Data analysis:

Utilizing data analysis tools to identify patterns, trends, and potential fraudulent activity within claims.

· Investigating claims:

Contacting policyholders, providers, or other relevant parties to gather additional information and verify claim details.

· Claim adjudication:

Making decisions on claim approvals or denials based on policy terms and investigation findings.

· Communication with stakeholders:

Communicating claim status updates to policyholders, providers, and internal departments.

· Compliance monitoring:

Ensuring claims processing adheres to relevant regulations and company policies.

· Fraud detection:

Identifying potential fraudulent claims and initiating appropriate investigations.

· Reporting and analysis:

Generating reports on claims trends and key metrics to inform decision-making.

Required skills for a claims analyst:

• Analytical skills: Strong ability to interpret data, analyze complex information, and draw accurate conclusions.
• Attention to detail: High level of accuracy when reviewing claim details and identifying discrepancies.
• Problem-solving skills: Ability to identify issues within claims and develop effective solutions.
• Communication skills: Clear and concise communication with policyholders, providers, and internal teams.
• Computer proficiency: Familiarity with claims processing systems and data analysis software.
• Knowledge of insurance policies and regulations: Understanding of relevant insurance policies, legal requirements, and industry standards.

Typical education and experience for a claims analyst:

• Bachelor's degree in business, finance, or a related field
• Prior experience in the insurance industry, particularly in claims processing, is often preferred.

Job Types: Part-time, Temporary

Expected hours: No more than 24 per week

Schedule:

• 8 hour shift

Work Location: In person