Claims Analyst Jobs
What is a Medical Claims Analyst?
A Medical Claims Analyst plays a critical role in the healthcare and insurance industries by ensuring the accurate and efficient processing of medical insurance claims. Their work helps maintain financial integrity, reduce fraud and ensure patients receive appropriate coverage.
What does a Claims Analyst do?
Key job responsibilities for a claims analyst may include:
Review and analyze medical claims for accuracy and completeness
Verify diagnoses, procedures, and services against insurance policies
Apply correct medical coding (e.g., ICD-10, CPT)
Identify and investigate potentially fraudulent or suspicious claims
Communicate with healthcare providers and insurance companies to resolve discrepancies
Ensure compliance with healthcare regulations and payer guidelines
Maintain detailed records and generate reports on claims trends and issues
Recommend improvements to streamline claims processing and reduce costs
How to Work as a Claims Analyst
A Claims Analyst in the healthcare field processes medical claims by verifying and updating information about submitted claims and reviewing the work processes required to determine reimbursement. They would be responsible for providing billing analyses of claims and applying standards of federal regulations to ensure correct billing practices.
Skills and qualifications needed:
Strong knowledge of medical terminology and coding systems
Attention to detail and analytical thinking
Familiarity with healthcare reimbursement practices and insurance policies
Proficiency in claims management software and data analysis tools
Excellent communication and problem-solving skills
A Bachelor’s degree in a related field is preferred and in some cases a current nursing certification is required
Where Do Claims Analysts Work?
Medical claims analysts are found in a variety of healthcare environments, including but not limited to:
Health insurance companies
Managed care organizations
Hospitals and health systems
Third-party administrators (TPAs)
Government agencies (e.g., Medicare, Medicaid)
Medical billing and coding firms
Your Career, Your Way
At HealthCare Support, we don’t just help you find a job, we help you build a career that reflects your goals, values and potential. With a dedicated recruiting specialist by your side, our personalized hiring process is designed to uncover opportunities that truly fit. If you're ready to make a meaningful impact in healthcare and want a partner who’s invested in your success, HealthCare Support is where your journey begins.