A Claims Analyst will monitor the liability status of the Client from start to finish and also verify and update the information of the submitted claims. The common work tasks depicted on the Claims Analyst Resume include the following – reviewing the policies and determining if the charges are eligible for reimbursements, negotiating payments with parties, reconciling claims adjusters estimates, ensuring payments are done, verifying if the damages get covered in the respective policy and checking the claims to ensure accuracy and completeness.
Even though the job duties vary based on the type of industry, candidates applying for the role are expected to have strong communication skills and show proficiency in mathematical calculations. Persistence and natural curiosity are also expected. The applicant should also show familiarity with computer and relevant accounting software. Detailed researching skills will be appreciated. Many employers want the candidates to be educated to a degree level.
Objective : Dedicated Claims Analyst with 2 years of experience in claims processing and resolution. Proven expertise in analyzing claims data, identifying discrepancies, and collaborating with cross-functional teams to enhance claim accuracy. Committed to delivering exceptional service while adhering to compliance standards and improving operational efficiency.
Skills : Effective Communication Skills, Analytical Thinking, Attention To Detail, Data Analysis
Description :
Served as a liaison between departments, ensuring effective communication regarding claims and billing.
Identified and recommended improvements for claims processing systems to enhance efficiency.
Analyzed claim data to detect under and over-payments, ensuring accuracy in financial reporting.
Acted as a subject-matter expert in billing and claims, providing guidance to team members.
Reviewed provider contracts for compliance with Medicaid guidelines, ensuring correct setup in systems.
Worked with Provider Relations to foster positive relationships through education on billing processes.
Evaluated contract language for accuracy in rates and fee schedules, ensuring alignment with company policies.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in BA
Insurance Claims Analyst Resume
Objective : Analytical professional with 2 years of experience in insurance claims management. Skilled in evaluating claims data, ensuring compliance with industry standards, and enhancing operational efficiency. Eager to leverage expertise in claims processing and cross-functional collaboration to deliver exceptional service and drive improvements in claims resolution.
Skills : Proficient In Microsoft Office Suite, Claims Evaluation And Analysis, Conflict Resolution, Research Skills, Decision Making
Description :
Analyzed insurance claims to determine validity and compliance with policy terms.
Reviewed documentation to assess claim accuracy and completeness.
Ensure compliance of submitted claims with HUD regulations through thorough documentation reviews.
Decide on claims outcomes based on detailed analysis of claims and supporting documentation.
Communicate with financial institutions to obtain missing documentation or clarification of claims submissions.
Organize and batch completed claims for submission to HUD.
Utilize claims management software to track and report on claims status effectively.
Experience
0-2 Years
Level
Junior
Education
B.S. in Bus. Admin.
Claims Analyst Resume
Headline : Accomplished Claims Analyst with 7 years of experience in claims management and data analysis. Expertise in resolving complex claims issues, ensuring compliance with regulatory standards, and enhancing operational efficiency. Adept at collaborating with multidisciplinary teams to improve service delivery and drive continuous improvement in claims processes.
Skills : Claims Data Analysis, Strategic Problem Solving, Workflow Management, Trend Analysis, Case Management, Legal Knowledge
Description :
Audit patient treatment records for accuracy and compliance with established criteria.
Evaluate reimbursement levels by analyzing claims against benefit packages.
Conduct thorough audits on processed claims to ensure accuracy and adherence to policies.
Execute regular check runs to meet and exceed processing time standards.
Manage the processing of specialty, ancillary, and emergency claims through diligent review and auditing.
Design and deliver training programs based on audit findings to enhance team performance.
Oversee a quality assurance program to support continuous performance management and improvements.
Experience
5-7 Years
Level
Senior
Education
B.S. BA
Disability Claims Analyst
Resume
Objective : Motivated Disability Claims Analyst with 2 years of experience in claims evaluation and processing. Proficient in interpreting complex claim data, ensuring compliance with regulations, and enhancing service quality. Passionate about supporting individuals with disabilities and committed to optimizing claims outcomes through detailed analysis and effective communication.
Skills : Claims Analysis, Claims Administration, Data Management Software, Team Collaboration, Cross-functional Teamwork, Technical Proficiency
Description :
Provide comprehensive support to policyholders, agents, and brokers regarding disability claims.
Ensure timely and accurate responses consistent with service standards.
Gather necessary information from clients to complete claims accurately.
Analyze claims to determine eligibility and the extent of the company's liability.
Apply knowledge of benefit contracts, healthcare terminology, and government regulations.
Manage claims and products effectively, including grievance processes.
Issue refunds for overpayments and coordinate with providers when necessary.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in Health Admin
Claims Analyst Resume
Objective : Driven Claims Analyst with 2 years of experience in claims evaluation and management. Proficient in assessing claims for compliance, identifying discrepancies, and streamlining processes to enhance operational efficiency. Seeking to apply analytical skills and attention to detail to optimize claims resolution and provide exceptional service.
Conducted comprehensive analysis of medical claims, ensuring compliance with accounting principles and legal guidelines, fully adhering to HIPAA regulations.
Collaborated with healthcare providers and insurance representatives to resolve complex claims issues and discrepancies.
Utilized Electronic Medical Records (EMR) software to manage claims processing efficiently, ensuring timely billing to Medicaid and Medicare.
Verified and updated submitted claims information, negotiating payments and resolving discrepancies.
Monitored payment progress and maintained compliance with HIPAA and health facility policies.
Maintained a thorough understanding of relevant laws and guidelines related to medical claims.
Specialized in data entry and the completion of insurance paperwork, enhancing overall processing accuracy.
Experience
0-2 Years
Level
Junior
Education
B.S. in BA
Billing Claims Analyst
Resume
Objective : Seasoned Billing Claims Analyst with 5 years of experience in healthcare claims processing and dispute resolution. Expertise in evaluating claims data for compliance, enhancing operational efficiency, and optimizing customer service. Passionate about leveraging analytical skills to improve claim accuracy and drive organizational success.
Skills : Proficient In Ms Office Suite And Project Management Software, Claims Project Management, Cross-functional Team Coordination, Regulatory Compliance
Description :
Review and analyze claims for accuracy and compliance with Long Term Care insurance policies.
Draft approval and denial correspondence in accordance with regulatory standards.
Train new employees on claims processing policies and procedures, improving team performance.
Ensure timely and accurate claims payments, adhering to state regulations and company standards.
Identify potential exposures and report findings to senior management for strategic decision-making.
Communicate effectively with policyholders and providers to resolve inquiries and disputes.
Oversaw the implementation of IBM DataCap for efficient indexing of incoming claims documentation.
Experience
2-5 Years
Level
Consultant
Education
B.S. Health Admin.
Claims Analyst Resume
Objective : Results-oriented Claims Analyst with 2 years of experience in managing and processing claims. Expertise in validating claims, ensuring compliance with regulations, and enhancing operational workflows. Adept at collaborating with diverse teams to drive efficiency and improve claim outcomes while maintaining a strong focus on customer satisfaction.
Skills : Data Analysis Software, Claims Management Systems, Claims Processing, Claims Documentation, Data Entry Accuracy, Fraud Detection
Description :
Input and manage data in an electronic claims system to ensure accuracy and compliance.
Review medical billing for appropriateness and adherence to industry standards.
Validate the legitimacy of medical claims submitted by physicians and hospitals.
Ensure all claims comply with current healthcare regulations and insurance policies.
Analyze medical claims to facilitate accurate payments to providers.
Contributed to reducing claim backlog, aligning with industry standards.
Regularly update claims processing procedures to enhance efficiency.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in BA
Special Claims Analyst
Resume
Headline : Dynamic Special Claims Analyst with 7 years of comprehensive experience in claims evaluation and resolution. Demonstrated ability to analyze complex claims data, identify discrepancies, and implement process improvements. Committed to optimizing claims outcomes while ensuring compliance with regulatory standards and enhancing client satisfaction.
Developed in-depth understanding of client processes to strategically analyze and enhance accounts receivable functions.
Conducted regular audits of claims submissions to ensure accuracy and compliance.
Provided expert guidance on claim corrections and resolutions, improving client satisfaction.
Prepared analytical reports identifying trends and recommending quality improvement initiatives.
Handled advanced claims issues, ensuring satisfactory resolutions for escalated cases.
Documented client issues in tracking systems, facilitating effective communication and follow-up.
Collaborated with management to address client concerns and enhance service delivery.
Experience
5-7 Years
Level
Management
Education
B.S. in BA
Claims Analyst Resume
Objective : Results-driven Claims Analyst with 5 years of extensive experience in claims evaluation and resolution. Adept at analyzing complex claims data, ensuring compliance with industry regulations, and implementing process improvements. Committed to optimizing claims outcomes and enhancing service delivery through effective collaboration and analytical expertise.
Skills : Claims Communication Skills, Problem Solving, Claims Processing Management, Communication Skills, Negotiation Skills, Report Writing
Description :
Conduct comprehensive claims research utilizing Fiscal Intermediary Shared System (FISS) to analyze Medicare claims denials.
Effectively communicate findings to nursing staff, facilitating timely resolution of denied claims.
Track and report on productivity and quality metrics to identify process improvements.
Utilize Microsoft Office Suite for data management, reporting, and documentation.
Prepare detailed reports and correspondence regarding claims status in compliance with company protocols.
Sort and compile data electronically, ensuring accuracy and efficiency in information retrieval.
Perform meticulous data entry, validating information against source documents to prevent errors.
Experience
2-5 Years
Level
Junior
Education
B.S. in BA
Associate Claims Analyst Resume
Objective : Enthusiastic Associate Claims Analyst with 2 years of experience in efficiently processing and resolving claims. Skilled in data analysis, identifying irregularities, and working collaboratively to improve claim accuracy. Focused on maintaining compliance and delivering high-quality service while driving process enhancements.
Handled customer inquiries via calls, emails, and written correspondence regarding quality and liability claims.
Tracked progress of current and past claims, ensuring timely updates to customers.
Evaluated and processed claims in the lab, ensuring accuracy and compliance.
Provided exceptional customer service while adhering to quality assurance standards.
Utilized Microsoft Excel, Access, and Oracle to manage and process customer claims.
Generated weekly claims analysis reports to identify trends and areas for improvement.
Collaborated with cross-functional teams to enhance product knowledge and service delivery.
Experience
0-2 Years
Level
Entry Level
Education
B.S.B.A.
Claims Analyst Resume
Summary : Accomplished Claims Analyst with a decade of experience in claims processing and resolution. Expertise in evaluating complex claims, ensuring compliance, and enhancing operational efficiency. Proven ability to collaborate with multidisciplinary teams to drive improvements in claims management and deliver exceptional service to clients.
Skills : Claims Analysis And Resolution, Time Management, Critical Thinking, Insurance Knowledge, Statistical Analysis
Description :
Conduct thorough reviews and analyses of claims and loss expense reserves set by insurance carriers.
Serve as a key liaison between insurance carriers and brokers to ensure accurate loss expense reserves.
Provide administrative support to the Director of Risk Management, enhancing operational workflows.
Develop and implement best practices for claims processing to improve efficiency.
Evaluate and enhance claims documentation processes to ensure compliance with regulations.
Train junior staff on claims evaluation and processing standards.
Collaborate with cross-functional teams to resolve complex claims issues effectively.
Experience
7-10 Years
Level
Management
Education
B.S.B.A.
Warranty Claims Analyst
Resume
Objective : Detail-oriented Claims Analyst with over 5 years of experience in evaluating and processing insurance claims. Proficient in analyzing data, identifying discrepancies, and ensuring compliance with regulations. Strong communication skills and a proven track record of resolving complex claims efficiently while maintaining high customer satisfaction.
Conducted thorough claims adjudication and review, applying contract benefits accurately.
Identified and reported irregularities in claims processing, contributing to enhanced accuracy.
Logged pertinent information into claims notes, ensuring comprehensive documentation.
Maintained a productive work environment by promoting teamwork and compliance with policies.
Implemented quality improvement initiatives within the claims processing framework.
Adhered to guidelines outlined in the PH Tech Personnel Handbook, ensuring compliance.
Reviewed and followed all required policies and procedures to maintain operational integrity.
Experience
2-5 Years
Level
Consultant
Education
B.S.B.A.
Claims Analyst Resume
Objective : Claims Analyst with two years of hands-on experience in claims evaluation and processing. Adept at analyzing claims data to identify discrepancies and ensure compliance with industry regulations. Proven ability to collaborate effectively with cross-functional teams, enhancing claim resolution efficiency and customer satisfaction.
Skills : Documentation Skills, Data Interpretation, Claims Investigation, Presentation Skills, Work Ethic, Empathy
Description :
Reviewed and analyzed claims related to defective materials, identifying and mitigating financial exposure.
Acted as a liaison between Flooring Services and vendors, ensuring accurate reporting of loss expenses.
Processed new claims and directed them to appropriate vendors for resolution.
Facilitated communication between builders, homeowners, and contractors to gather necessary information for claims.
Collaborated with sales representatives and inspectors to address incidents that could affect claims outcomes.
Coordinated logistics for affected parties, including movers and lodging, in cases of material defects.
Prepared comprehensive correspondence and reports documenting claims status and resolutions.
Experience
0-2 Years
Level
Junior
Education
B.S.B.A.
Assistant Claims Analyst Resume
Objective : Results-focused Assistant Claims Analyst with 2 years of experience in claims assessment and resolution. Expertise in data analysis, identifying claim discrepancies, and ensuring compliance with industry standards. Passionate about enhancing operational efficiency and delivering superior service through effective collaboration and problem-solving strategies.
Investigated and adjusted Proof of Claims (POC) and Notice of Determination (NOD) submissions to ensure accuracy.
Managed Allocated Loss Adjustment Expense (ALAE) projects to optimize claim settlements.
Reviewed and adjusted invoices submitted for payment, ensuring compliance with policies.
Updated reserves for various claims, including construction defects and liability issues.
Accessed and analyzed multiple data systems to match POCs with existing claims.
Recommended coverage decisions based on thorough claim analysis.
Handled complex liability claims, ensuring thorough investigation and resolution.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in BA
Claims Analyst Resume
Objective : Resourceful Claims Analyst with 2 years of hands-on experience in claims evaluation and resolution. Adept at scrutinizing claims data, ensuring compliance, and driving process improvements. Passionate about enhancing operational efficiency and delivering top-notch service to clients while effectively collaborating with diverse teams.
Skills : Excel Proficiency, Data Analysis Tools, Time Tracking, Risk Management, Technical Writing
Description :
Communicated with policyholders regarding claim status and required documentation.
Surpassed the individual claim limit by efficiently managing an average of 300 claims per week.
Led a pilot team for senior analysts, specializing in complex claims and serving as the primary resource for team inquiries.
Provided exceptional customer service to major clients, successfully managing international claims through bilingual communication.
Addressed and transitioned complex situations across multiple claims management software and operating systems.
Demonstrated strong multitasking abilities while managing various tasks simultaneously.
Assisted team members in interpreting complex policy language and special handling procedures.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in BA
Senior Claims Analyst/Manager Resume
Summary : Results-oriented Senior Claims Analyst with 10 years of experience in claims management and resolution. Expertise in analyzing complex claims data, ensuring compliance, and driving process improvements. Proven ability to lead cross-functional teams, optimize workflows, and enhance operational efficiency while delivering exceptional service to clients.
Coordinated benefits and verified eligibility for diverse insurance plans.
Analyzed coding of operative reports and complex surgical procedures to ensure accuracy.
Evaluated claims for medical management, ensuring thorough documentation.
Trained claims staff on best practices in claims processing and compliance.
Advised examiners on monitoring departmental quality and production goals.
Maintained accurate records and prepared comprehensive reports on claims activities.
Responded to inquiries from providers and members regarding claim statuses.
Experience
7-10 Years
Level
Management
Education
B.S. in BA
Senior Claims Analyst Resume
Summary : Insightful Senior Claims Analyst with a decade of experience in managing complex claims and driving operational excellence. Proven track record in data analysis, compliance adherence, and process optimization. Adept at collaborating with diverse teams to enhance claims accuracy and deliver superior client service while implementing innovative solutions.
Skills : Attention to Detail, Problem Solving, Communication Skills, Negotiation Skills, Report Writing
Description :
Provided expert administrative support to the Network Manager, enhancing operational workflow.
Designed and implemented a training program for new hires, significantly improving onboarding efficiency.
Ensured rapid resolution of customer inquiries while maintaining strict adherence to company policies.
Processed a high volume of medical and dental claims with precision and accuracy.
Assisted the claims manager in reviewing surgical procedures to ensure adherence to R&C standards.
Analyzed reinsurancestop loss reports quarterly to identify trends and areas for improvement.
Managed client communications, addressing claim-related issues to ensure compliance with company policies.
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