Insurance Claims Analyst 04F25

The Insurance Claims Analyst plays a pivotal role in the claims processing department by reviewing and analyzing insurance claims to ensure accuracy, completeness, and compliance with company policies and regulatory requirements. This position requires a keen eye for detail and the ability to interpret various forms of data to make informed decisions regarding claims approval or denial. The analyst interacts with a range of stakeholders, including claimants, adjusters, and industry experts, to gather necessary information and resolve any issues promptly. This role demands strong analytical skills, excellent communication abilities, and an understanding of complex insurance terms and practices. The Insurance Claims Analyst is essential in maintaining the integrity of the insurance process, ensuring fair and timely resolutions while minimizing risk and financial exposure for the company.

Responsibilities

• Review and assess insurance claims to determine validity and authenticity.
• Analyze detailed reports and documentation to evaluate claim accuracy.
• Coordinate with claimants and third-party service providers for required information.
• Liaise with internal teams to ensure comprehensive claims assessment procedures.
• Ensure all claims are processed in compliance with regulatory standards and company policies.
• Identify any discrepancies in claims submissions and address them appropriately.
• Prepare detailed reports and summaries for management on claim status and outcomes.
• Assist in fraud detection by analyzing patterns and potential red flags in claims.
• Respond promptly and effectively to inquiries related to claims processing.
• Maintain and update accurate records of claims and communicate findings to stakeholders.
• Participate in regular training sessions to stay updated on industry best practices.
• Contribute to process improvement initiatives to enhance claims analysis efficiency.

Requirements

• Bachelor's degree in finance, insurance, or a related field preferred.
• Minimum of three years of experience in insurance or claims analysis.
• Strong analytical skills with an eye for detail and accuracy.
• Excellent verbal and written communication skills required.
• Proficiency in using claims management software and Microsoft Office Suite.
• Ability to work under pressure and manage multiple deadlines simultaneously.
• Knowledge of insurance policies, procedures, and applicable regulations.