Claims Analyst Job Description, Key Duties and Responsibilities
If you are searching to know what the job description of a claims analyst is, then you are on the right page. You will be fully informed here of the key duties, tasks, and responsibilities that make up the claims analyst work description.
You will also learn from this post the requirements you will need to meet if you are applying for the claims analyst role at most organizations.
Please, continue reading:
What Does a Claims Analyst Do?
Claims analysts are responsible for monitoring the totality of a liability claim. They review insurance claims for accuracy, completeness, and eligibility.
They are also responsible for managing liability and workers’ compensation claims.
They work for insurance companies, medical billing departments, private organizations, and government agencies.
The claims analyst job description entails maintaining updated records and preparing required documentation.
It also involves assisting in controlling the cost of processing claims and contacting policyholders about claims, as well as providing information regarding the amount of benefits when necessary.
The claims analyst’s role requires for the individual to use their analytical skills to project potential losses and make recommendations to limit risk.
It also involves performing a thorough review for proper claim strategy to ensure that TPA adheres to Best Practice claims management and reserving of assigned indemnity and medical only claims.
The claims analyst is also responsible for escalating the TPA’s failure to demonstrate Best Practice claims management in any pending workers’ compensation claim.
They are responsible for identifying loss trends.
They also work closely with the Risk Manager and Director of Safety (where applicable) to assist in mitigating such trends as necessary.
The claims analyst work description entails communicating with external vendors to obtain data needed for analyses.
It also involves utilizing ETL software to gather and analyze data.
The analyst is responsible for the development, maintenance, and distribution of historical trend analysis reports related to departmental/company performance.
To become a claims analyst requires a minimum of High School Diploma combined with specialized experience, but some organizations may prefer a Bachelor’s degree.
Individuals seeking to get into the claims analyst career are also required to have analytical, research, and communication skills, as well as strong mathematical and computer skills to perform the job successfully.
Claims Analyst Job Description Example/Sample/Template
Claims analysts perform various functions which primarily involve analyzing, advising, and managing workers’ compensation, general liability, property, builders’ risk, and auto claims.
When employed in an insurance company, the emphasis of their job is on reviewing claims filled by policyholders for completeness and accuracy, as well as establishing that the damages are covered by their policies.
The typical claims analyst job description is shown with the example below, consisting of major tasks, duties, and responsibilities that commonly define the role:
- Manage workers entire claim compensation process
- Review all requests for claim denial, clear data and claim exceptions, and ensure deficiencies are flagged correctly
- Ensure eligibility for claims is reasonable and correct by analyzing claims and supporting documentation
- Responsible for sending process claimant responses, including deficiency and rejection letters
- Provide support in handling general liability, property, builders’ risk, and auto claims where applicable
- Responsible for managing all claims related activities with TPA /adjusters on a daily basis
- Responsible for analyzing claims and interpreting insurance policies
- Work in coordination with the legal department to resolve all claims and non-litigated matters
- Assess and authorize claim settlements when provided with a given limit of authority
- Communicate updates, claim information requests, and recommendations to all relevant units
- Responsible for the review and tracking of all incidents reports, and ensure to follow up for additional information where necessary
- Responsible for managing, reviewing, and approving legal referrals to ensure consistency with established claims management protocols
- Utilize client relationship software (e.g. Salesforce.com) to document client conversations
- Attend claim review with senior manager on quarterly basis or as needed
- Responsible for escalating claim quality concerns and outcomes to senior manager or the appropriate unit.
Requirements- skills, knowledge, and abilities- for a Claims Analyst
When hiring for the post of claims analyst, HR managers or recruiters typically give a list of requirements for interested persons for the job to meet to prove that they can effectively perform the purpose, obligations, and objectives of the claims analyst role as defined by the company.
Shown below are major claims analyst requirements you may be asked to fulfill if you are applying for the position:
- Education: Applicants for the claims analyst role require a minimum of High School Diploma, but a Bachelor’s degree with emphasis on risk management, business or finance, or a field relevant to the industry of the recruiter may be preferred
- Knowledge: They may be required to possess a working knowledge of financial products (e.g. stocks, bonds, and options). It is also essential that they possess the ability to comprehend, explain, and apply court approved, complex plans of allocation; and a working knowledge of corporate actions (e.g. stock splits, mergers, bond conversions, and employee stock options)
- Computer skills: They require intermediate knowledge of Microsoft applications, but advanced knowledge of Excel and ability to work with relational databases and statistical modeling software (e.g. SAS, SPSS, etc.) is preferred
- Communication skills: They require excellent verbal and written communication skills to communicate effectively with employees at all levels of the organization
- Mathematical skills: They require the ability to undertake mathematical manipulations such as discounts, interests, commissions, proportions, percentages, and volume
- Research skills: This is a crucial skill needed for claims analysts to undertake detailed research necessary for the verification of claims
- Presentation skills: This skill is essential for them to effectively present information to clients, managers, colleagues, and significant others
- Flexibility: They must be able to adapt to a fast-paced continually changing business and work environment while managing multiple priorities.
If you are a recruiter/HR manager looking to hire for the role of a claims analyst, you can quickly create a detailed description that perfectly defines the duties and responsibilities of the claims analyst position in your company by applying the sample job description above.
You will also find this post helpful if you are interested in the claims analyst career. It will help you to learn all you need to know about the duties and responsibilities of the role and make you better prepared for the job ahead.
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