Claims Analyst Job Description

Claims Analyst Job Description, Skills, and Salary

Get to know about the duties, responsibilities, qualifications, and skills requirements of a claims analyst. You can use our job description template in this article to produce your own. We also provide you with information about the salary you can earn as a claims analyst.

 

Who is a Claims Analyst?

A claims analyst is a specialist who reviews insurance claims to determine their accuracy. However, their responsibilities are primarily administering, advising on, and analyzing claims about workers’ compensation, general liability, property, builders’ risk, and automobiles.

Additionally, claims analysts choose which claims can be paid out immediately and which require further investigation before a decision can be made.

They work with various insurance plans for property, casualty, car, health, and life.

 

Claims Analyst Job Description

Below are the claims analyst job description examples you can use to develop your resume or write a job description for your employee. Employers can also use it to sieve out job seekers when choosing candidates for interviews.

The duties and responsibilities of a claim analyst include the following:

  • Submit payment claims for approval to an insurer.
  • Confirm eligibility, figure out what’s owed, and process payment claims.
  • Help keep the cost of reaching out to policyholders and handling claims in check.
  • Make projections for prospective losses and recommendations for risk reduction.
  • Respond to claimants and include rejection and deficiency letters.
  • Inform the appropriate unit or senior manager of your concerns and findings regarding claim quality.
  • Monitor, evaluate, and handle claims following the company’s policies and procedures.
  • Verify the claims handled by less experienced workers for quality.
  • Examine discrepancies in claim processing, keep an eye out for indications of fraud, and verify the accuracy and completeness of all supporting documentation.
  • Learn more about claims that need more research, and speak to patients, doctors, or other healthcare professionals.
  • Interpret policies and procedures to ensure that claims processing is carried out properly.
  • Verify that claim information is accurate and follow all legal requirements before submitting to a state or federal agency.
  • Keep track of client conversations using client relationship management software, such as Salesforce.com.
  • Look into claims to determine whether processing or adjudication errors occurred.
  • Attend continuing education seminars to stay current on best practices.
  • Check billing statements, medical records, and other documents to determine the validity of claims for payment.
  • Keep abreast of recent developments in the insurance industry.
  • Take note of state and federal laws changes that may affect claims processing.
  • Follow any modifications to local, state, and federal legislation, as well as any advancements in the insurance sector that might affect the handling of claims.
  • Perform any other duty assigned to you.

 

Qualifications

The qualification of a claims analyst include the following:

  • Bachelor’s degree in accounting, business, finance, or a similar field.
  • Ability to mathematically calculate discounts, interests, commissions, ratios, percentages, and volume.
  • 3 to 5 years of experience in auditing, claims analysis, or a related position.
  • Good investigative and research skills.
  • Experience in the insurance industry.
  • Working knowledge of financial instruments like stocks, bonds, and options.
  • Expertise in data mining and statistical analysis.
  • Excellent analytical skills, attention to detail, and medical billing and coding expertise.
  • Ability to comprehend, express, and apply complex allocation plans that have received court approval.
  • Capacity to work both independently and collaboratively.

 

Essential Skills

The essential skills of a claims analyst include the following:

  • Critical Thinking:

Claims analysts must regularly make decisions involving insurance claims. Thus, critical thinking is essential. Critical thinking is the capacity to evaluate a situation and conclude based on the information critically. When deciding whether to accept or reject a claim, your capacity for critical thought can assist you in making the optimal decision.

  • Organization skill:

Claims analysts keep a range of records, files, and data. As a claims analyst, you might need to examine several different files or records for each claim that comes in. You can find what you need more quickly and successfully if you are well organized. Being organized is essential when producing reports to convey correct data and information.

  • Claims processing:

Utilizing their knowledge of insurance claims, analysts process and approve claims. This comprises reviewing the specifics of a claim, determining whether the company is liable for it, and calculating how much money the claimant deserves. Additionally, processing claims requires calculating any fees associated with the claim and putting all necessary information into an automated system.

  • Analysis skills:

Claims analysts use their analytical skills to determine each claim’s best line of action. They must be able to assess all pertinent aspects of a problem and take into account all feasible outcomes before proposing suggestions or solutions.

This could require looking into the rules, regulations, and practices that apply to various claims and other factors that could affect a claim.

  • Systems Awareness:

A claims analyst needs to be familiar with the systems and practices of an insurance business. They need to know how claims are handled, what information clients must provide, and what procedures different company divisions follow.

  • Problem-Solving skill:

The claims analyst is responsible for looking into and handling insurance claims. This calls for a thorough understanding of the insurance policy and the ability to identify the cause of the claim and the best course of action to take.

  • Research prowess:

Research capacity is a necessary trait for a claims analyst. They employ their research abilities to obtain information about clients’ claims, such as medical records, insurance information, and other facts, to make informed choices about claims. They also use their research abilities to find solutions for problems that come up during the claims process.

  • Communication abilities:

Claims analysts need to be able to speak clearly with customers and coworkers. Strong communication abilities enable you to clearly explain complex topics, ensuring that everyone involved knows what needs to be done next. Another essential part of communication is listening. This skill can be used to ask clarifying questions and ensure everyone comprehends an idea.

  • Attention to detail

Attention to detail is a crucial quality for claims analysts since they must be able to evaluate and analyze vast amounts of data and information to find any errors or inconsistencies. This skill can help you ensure that the company pays the correct taxes and is not liable for any claims.

  • Fraud Detection:

The ability of a claim analyst to recognize whether a customer is falsifying an insurance claim serves as an effective fraud detector. Claims analysts use this skill to ensure that customers are adequately reimbursed for their losses.

  • Legal interpretation:

A claims analyst must be able to comprehend and use company policies when evaluating a claim. For this, it is important to comprehend the many types of insurance, such as health, life, and property insurance, and how each sort of coverage functions. To select the type of policy most appropriate for a certain situation, it is also necessary to comprehend the numerous coverage possibilities provided by each form of policy.

  • Adjudication:

Claim analysts should be conversant with the decision-making process for insurance claims. Claims analysts decide whether and how much a corporation should pay out on a claim using their adjudication skills. They could also examine compensated claims to ensure the correct sum was paid. They need to know the procedures, laws, and regulations governing insurance claims to achieve this.

  • Flexibility:

Claims analysts ought to be able to adapt to changing circumstances. You might have to adjust your working hours or switch focus from one task to another if you work as a claims analyst. Flexibility can help you be more successful and productive as a claims analyst since it allows you to react quickly when necessary.

  • Knowledge of customer service:

Claims analysts require great customer service skills because they typically work with clients who have experienced a loss. For clients to know what to expect, they must be able to listen to their concerns and thoroughly explain the claim filing procedure. Empathy is a key customer service competency when interacting with people who have been touched by an accident or a natural disaster.

 

How to Become a Claims Analyst

Individuals interested in becoming a claims analyst can follow the steps below to get started:

  • Step 1: Earn a Degree

To begin a career as a claims analyst, you normally need a bachelor’s degree in business or a closely related discipline in order to be competitive with employers. While obtaining your degree, think about taking statistics, economics, accounting, data analysis, and computer science classes to develop a strong foundation of understanding in these subjects. As you develop your ability to evaluate huge volumes of data and make judgments based on that knowledge, you will comprehend these subjects better.

  • Step 2: Complete a training program or internship in your field

To gain the requisite on-the-job abilities, a Claims Analyst internship may be necessary before entering the profession.

After employment, claim analysts receive between one and two years of on-the-job training. During this time, new claims analysts acquire the skills and knowledge required for their specific position and employer.

One of the industries where claims analysts can enroll for an internship is an insurance firm. An internship can teach you much about the insurance business and give you experience. Internships are also a wonderful method to network with business leaders who may be able to assist you in finding employment or other possibilities once you graduate.

Working as an intern for an insurance company will give you expertise in the claims procedure from both the client and business viewpoints. Additionally, you can get hands-on training on using the software programmes employed by analysts and adjusters in the insurance sector.

  • Step 3: Develop experience dealing with clients and claims

While obtaining your bachelor’s degree, consider applying for entry-level positions with insurance businesses. These jobs usually involve assisting customers with insurance claims and reviewing policy paperwork to ensure the company upholds its duties. This experience can help you improve your customer interactions and policy evaluation skills.

  • Step 4: Secure Employment as an Entry-Level Claims Analyst

Once you have a bachelor’s degree in business or a closely related profession, you can begin your career as an entry-level claims analyst. For most jobs as a claims analyst, a four-year bachelor’s degree in a relevant discipline is necessary. Depending on the kind of claims analyst position you’re pursuing, you might want to check into certification as a certified emergency medical technician or certified paramedic.

You could work as a claims adjuster or underwriter before becoming an insurance claims analyst. Adjusters are in charge of investigating claims and determining the amount the company should pay. Underwriters evaluate applications for coverage before deciding whether to approve them.

  • Step 5: Become a Certified Claims Analyst

By looking at your certifications, employers can see that you have the knowledge needed for the job. They might make you seem like a more desirable prospect as a result. A certification might enhance your application even if an employer does not require one. The certification procedure can also impart fresh knowledge to you that you can use at work. The most common credential is Associate in Claims (AIC). However, International Accredited Business Accountant is also regularly listed on resumes for claims analysts (IABA).

Below is a list of the claims analyst certifications you can obtain;

  1. Associate in Claims (AIC).
  2. International Accredited Business Accountant (IABA)
  3. Certified Medical office manager (CMOM).
  4. Associate In Insurance General  (AINS) certification.
  5. Certified Professional Coder (CPC).
  6. Certified Medical Insurance Specialist (CMIS).
  7. Managed Healthcare Professional (MHP).
  • Step 6: Join professional organizations, such as the National Association of Insurance Commissioners (NAIC)

The National Association of Insurance Commissioners (NAIC) works with state insurance departments to develop and implement standardized rules, regulations, and standards for the insurance business. The NAIC provides tools and training to professionals in the insurance industry through its several committees and task forces. By joining the NAIC, you may enhance your career and keep up with changes in the insurance sector.

  • Step 7: Keep abreast of changes in the claims Analyst sector

New rules and regulations may impact how claims are handled because the claims analyst sector is undergoing ongoing change. Keeping up with these changes is crucial for claims analysts to use them in their work. You can stay current on advancements by attending conferences or reading trade magazines.

Any adjustments to the company’s policies that may affect how you handle claims should also be known to you. You can ensure you follow all the necessary steps by routinely checking internal processes.

 

Where to Work as a Claims Analyst

Claims analysts work in various settings, including medical billing departments, private companies, insurance companies, self-insured corporations, third-party administrators, and governmental organizations. Although they frequently work standard business hours, they might need more time to fulfill deadlines or address urgent claims. In addition, claim analysts in insurance firms or self-insured sectors often work in offices, unlike those who examine claims for third-party administrators or government firms, who may travel to various locations.

 

Claims Analyst Salary Scale

In the US, a claims analyst’s income is between $44,984 and $54,795. However, salary ranges might differ dramatically based on several important aspects, such as education, qualifications, supplementary talents, and experience in the claims analyst profession.

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