Medical claims analysts typically work for insurance companies as the person who verifies or audits medical claims to ensure the accuracy of company reimbursement payments. They usually work at a computer workstation in an office environment. Because the job is highly computerized, many companies offer flexible, remote, or work-from-home shifts.
Medical claims analysts are typically expected to process a high volume of claims each day. To process a claim, they must analyze and verify the details submitted, check for conflicts, errors, or inconsistencies, and arrange for payment.
Accuracy and speed are the most important criteria for evaluating the work of claims analysts. Great attention to detail is important, but they must be able to meet all deadlines and work well under pressure.
A particularly-valuable skill is the ability to identify errors, problems, and inaccuracies in claim documentation and resolve them in a timely manner. Resolving these problems will also require strong communication skills, both written and verbal. These analysts must have vast knowledge of medical terminology, billing procedures, laws, and insurance policies in order to verify and document claim information. Because the ultimate goal of their work is to issue correct payments, claims analysts must also have excellent math skills to reconcile all documentation.
An Associate’s or Bachelor’s degree in Business is often required for this position, though some applicants prepare by completing a medical coding vocational program to gain the knowledge required for the job. Medical claims analysts must also have strong computer skills, especially pertaining to office applications and typing speed.
The occupational outlook for medical claims analysts is generally positive. As health care coverage is expected to expand continuously, the number of insurance claims is expected grow, as well. The U.S. Bureau of Labor expects this to lead to a rising number of claims-processing jobs in the insurance industry.
Medical Claims Analyst Tasks
Communicate with patients, payers and insurance to follow up and resolve claims.
Work with patients to set up payment plans and confirm coverage and claim status.
Process denials, refunds, appeals and claim status.
Create reports and documentation for regulatory bodies, lawyers and other groups.
Analyze database and contracts to make adjustments, report on current state and research claims.