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Become A Claims Analyst

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Working As A Claims Analyst

  • Getting Information
  • Communicating with Supervisors, Peers, or Subordinates
  • Establishing and Maintaining Interpersonal Relationships
  • Analyzing Data or Information
  • Organizing, Planning, and Prioritizing Work
  • Deal with People

  • Mostly Sitting

  • $49,920

    Average Salary

What Does A Claims Analyst Do At Unitedhealth Group

* Review and render determinations on Long Term Disability claims.
* Initiate and maintain appropriate level of communication within ERISA standards through the claim review and investigation process.
* Respond to all inquiries generated relative to Long Term Disability claims within established service time frame.
* Provide accurate claim decisions in accordance with Policy, State and Federal guidelines.
* Adjudicate Long Term Disability claims Analyzes and investigates.
* Provides explanations and interpretations within area of expertise

What Does A Claims Analyst Do At Lowe's

* The Claims Analyst will support the Workers Compensation Program by:
* Reviewing and negotiating settlement requests by third party administrators, providing authority up to 75k
* Reviewing and providing reserve adjustments made by third party administrators up to increments of $75k
* Conducting quarterly claims reviews with experienced workers compensation claim handlers, team leaders and defense attorneys; providing tactics for timely claims resolution
* Revising and maintaining claims handling policies and procedures to ensure compliance with Lowe’s corporate requirements
* Performing monthly quality assurance reviews on workers compensation files to verify compliance with both qualitative and quantitative standards as set forth by Lowe’s Risk Management and Industry Best Practices/Standards
* Performing quarterly vendor matrix analyses to assess vendor spend and performance, making recommendations on alternative solutions
* Preparing findings reports based on exception analyses and quality assurance reviews, making recommendations for enhancements or opportunities for improvements
* Developing and leading the training and education program of all field and CSC functions related to the Nurse Advocacy and Return-to
* Work programs to ensure operation effectiveness is maximized.
* This includes formulating communication to the field about changes in program enhancements via email notifications, our internal Connections websites, or via onsite presentations
* Conducting litigation management reviews quarterly to ensure compliance with fee arrangements
* Maintaining medical provider panel updates
* Reviewing and coordinating legal correspondence and subpoenas to ensure timely handling
* Reviewing/approving surveillance requests
* Special Projects

What Does A Claims Analyst Do At Johnson Controls

* Documents work-related injury incidents in EHSIS as they are telephone-reported by the BSNA field organization.
* Completes/submits the province-specific forms for each Canadian claim to the corresponding workers’ compensation boards within the time specified.
* Communicates with the injured employee’s supervisor.
* Receives incident information and determines if there are red flags relative to the incident, claim, or the employee.
* Reports incidents to the corresponding Regional Safety Representative and EHS Area Leader.
* Work with the Workers’ Compensation Managers to determine classification for each incident based on the information received in conjunction with the OSHA recordkeeping criteria and documents rationale in EHSIS.
* Tracks and documents open medical only claims in the EHSIS system.
* Also updates the status of open claims in the system as needed or directed.
* Where directed by the workers’ compensation manager, acts as a liaison between the Company and the injured employee, the treating doctor, and the third party administrators (TPA) or the corresponding provincial workers’ compensation boards.
* Where directed by the workers’ compensation manager, maintains communication with the injured employee, team leader, and TPA throughout the life of an incident.
* Documents all communications/information in the EHSIS system related to an incident or injury claim (incident information, investigation, medical treatment, employee and TPA conversations, etc.), communicates all information and status with the third party claims administrator, and manage all claims to closure.
* Provides claim status reports on a regular basis to the Workers’ Compensation Managers and EHS Managers as needed.
* Supports the Workers’ Compensation Managers with assisting in identifying medical clinics, arranging for post-accident drug tests, and anything that is needed to assist in the management of claims.
* Run reports from the EHSIS and TPA systems and provides claim status reports on a regular basis to the Workers’ Compensation Managers and EHS leaders

What Does A Claims Analyst Do At Advance Auto Parts

* include the following.
* Other duties may be assigned.
* Assist with managing third party administrator (TPA) adjusters to ensure compliance with claims handling instructions, achievement of performance goals, track workers’ compensation trends, identify opportunities to reduce losses based on claim trends and/or specific issues, and assist with claims service issues.
* Supervise workers’ compensation claims adjusters, field nurse case managers, and assist adjusters along with defense counsel on their investigation efforts.
* Assist in the evaluation of individual workers’ compensation claims in regards to reserve and settlement authority, claim handling direction, and selection of individual adjusters and claim service vendors.
* Directly impact (reduce) the costs and duration of claims.
* Administer Advance Auto Parts Claims Management Program, including:
* Review and processing claims and legal documents.
* Develop and maintain cross functional relationships to ensure full organizational support and participation with Workers’ Compensation claims teams and investigation process and programs.
* Review and analyze workers’ compensation files as assigned; ensure adequate reserves; review workers’ compensation subrogation claims; authorize 3rd party recoveries; partner with subrogation adjusters and Defense Attorneys to negotiate 3rd party recovery when necessary.
* Track, monitor and report on workers’ compensation claim trends to management.
* Monitor claim data quality from third party claims administrators and address deficiencies.
* Authorize workers’ compensation claim settlements and/or reserve increases within claim authority limits; convey recommendations to management relating to claim settlements anticipated to exceed established authority level.
* Partner with Operations, Asset Protection, Benefits, Human Resource Departments, Safety and Legal to ensure compliance with company policies, ADA, state workers’ compensation laws and other regulations.
* Establish diaries on claims to ensure focus on resolution and adherence to protocols.
* Manage litigation process in conjunction with TPA and work with Defense Attorneys to resolve assigned claims; participate in settlement negotiations and pre-trial and/or mediation conference calls.
* Assist in selecting and monitoring competent workers’ compensation defense attorneys.
* Proactively notify and work with management on claim files that are approaching and/or that exceed authority for this position.
* Track, monitor and report litigation trends to management.
* Administer workers’ compensation claim allocation process and related reporting.
* Collaborate with and assist the Risk Management Team Members, Safety and other business partners to identify adverse loss trends and to identify and develop strategies to reduce injuries.
* May act as a designated Risk Management representative at various internal and external meetings including settlement conference or mediations.
* Conduct special analysis/projects/assignments as requested.
* Assist with monthly roundtables, quarterly claim file reviews and annual audits with TPA and broker claims consultant to ensure that claims are proactively managed to conclusion in accordance with contractual agreements and that established reserves accurately reflect the anticipated value of pending claims

What Does A Claims Analyst Do At Charles River Laboratories

* Report and monitor claims to third party administrator
* Coordinate employee status with supervisors and HR representatives
* Work with legal representatives as associated with respective claims
* Create loss analysis reports
* Coordinate and participate within claim review meetings
* Enter and maintain claims in HRIS for OSHA reporting
* Provide authorization to treat to occupational health facilty
* Review contracts and coordinate insurance certificate program
* Develop insurance renewal information with worldwide offices
* Perform all other related duties as assigned

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How To Become A Claims Analyst

Most management analysts have at least a bachelor’s degree. The Certified Management Consultant (CMC) designation may improve job prospects.

Education

A bachelor’s degree is the typical entry-level requirement for management analysts. However, some employers prefer to hire candidates who have a master’s degree in business administration (MBA).

Few colleges and universities offer formal programs in management consulting. However, many fields of study provide a suitable education because of the range of areas that management analysts address. Common fields of study include business, management, economics, political science and government, accounting, finance, marketing, psychology, computer and information science, and English.

Analysts also routinely attend conferences to stay up to date on current developments in their field.

Licenses, Certifications, and Registrations

The Institute of Management Consultants USA (IMC USA) offers the Certified Management Consultant (CMC) designation to those who meet minimum levels of education and experience, submit client reviews, and pass an interview and exam covering the IMC USA’s code of ethics. Management consultants with a CMC designation must be recertified every 3 years. Management analysts are not required to get certification, but it may give jobseekers a competitive advantage.

Work Experience in a Related Occupation

Many analysts enter the occupation with several years of work experience. Organizations that specialize in certain fields typically try to hire candidates who have experience in those areas. Typical work backgrounds include experience in management, human resources, and information technology. 

Advancement

As consultants gain experience, they often take on more responsibility. At the senior level, consultants may supervise teams working on more complex projects and become more involved in seeking out new business. Those with exceptional skills may eventually become partners in their consulting organization and focus on attracting new clients and bringing in revenue. Senior consultants who leave their consulting company often move to senior management positions at nonconsulting organizations.

Important Qualities

Analytical skills. Management analysts must be able to interpret a wide range of information and use their findings to make proposals.

Communication skills. Management analysts must be able to communicate clearly and precisely in both writing and speaking. Successful analysts also need good listening skills to understand the organization’s problems and propose appropriate solutions.

Interpersonal skills. Management analysts must work with managers and other employees of the organizations where they provide consulting services. They should work as a team toward achieving the organization’s goals. 

Problem-solving skills. Management analysts must be able to think creatively to solve clients’ problems. Although some aspects of different clients’ problems may be similar, each situation is likely to present unique challenges for the analyst to solve.

Time-management skills. Management analysts often work under tight deadlines and must use their time efficiently to complete projects on time.

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Claims Analyst jobs

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Real Claims Analyst Salaries

Job Title Company Location Start Date Salary
Claims Analyst III HNTB Corporation New York, NY Oct 14, 2016 $92,518
Claims Analyst III HNTB Corporation New York, NY May 06, 2015 $90,022
Contracts & Claims Analyst Vivaldi Real Estate, Ltd. New York, NY Nov 01, 2014 $82,750
Marine Claim Analyst Senior/Severity AIG Claims, Inc. Jersey City, NJ Nov 23, 2015 $75,000
Claims Analyst III AIG Claims, Inc. New York, NY Sep 06, 2014 $75,000
Claims Analyst III AIG Claims, Inc. New York, NY Mar 05, 2014 $75,000
Claims Analyst III Chartis Claims, Inc. New York, NY Mar 05, 2012 $75,000
Analytic Claims Analyst Ameriprise Financial, Inc. Phoenix, AZ Feb 01, 2013 $71,800 -
$107,800
Claims Analyst Plymouth Rock Assurance Corporation Boston, MA Jun 29, 2010 $67,500
Claims Analyst AIG PC Global Services, Inc. New York, NY Feb 05, 2016 $65,656
Claims Analyst AIG PC Global Services, Inc. Berkeley Heights, NJ Feb 05, 2016 $65,656
Analyst, Claims American International Group, Inc. New York, NY Jul 08, 2013 $65,000
BP Oil Claims Loss Valuation Analyst Smith Stag, LLC New Orleans, LA Sep 17, 2013 $62,610
BP Claims Analyst Smith Stag LLC New Orleans, LA Oct 01, 2012 $62,610
Commercial Property Claims Analyst Halliwell Engineering Associates Aventura, FL Oct 01, 2015 $55,890
Analyst, Claims AIG PC Global Services, Inc. Olathe, KS Jan 09, 2016 $50,000
Claims Analyst Aspen Insurance U.S. Services Inc. New York, NY Sep 15, 2015 $47,757
Subrogation Claims Analyst Rawlings Group La Grange, KY Sep 17, 2016 $46,800
Claims Analyst Galleher Corporation Santa Fe Springs, CA Sep 15, 2015 $45,552
Contracts & Claims Analyst Vivaldi Real Estate, Ltd. New York, NY Sep 24, 2014 $43,702
Contracts & Claims Analyst Vivaldi Real Estate, Ltd. New York, NY Sep 24, 2014 $42,867
Contracts & Claims Analyst Vivaldi Real Estate, Ltd. New York, NY Oct 01, 2011 $41,740
Contracts & Claims Analyst Vivaldi Real Estate Ltd. New York, NY Oct 01, 2012 $41,740
Contracts & Claims Analyst Vivaldi Real Estate New York, NY Aug 01, 2012 $41,740
Contracts &Claims Analyst Vivaldi Real State Ltd New York, NY Oct 01, 2012 $41,740
Contracts & Claims Analyst Vivaldi Real Estate, Ltd. New York, NY Sep 23, 2011 $41,740

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Top Skills for A Claims Analyst

BankProceduresProviderContractsCustomerServicePolicyProvisionsMedicalProvidersMedicalClaimsLiabilityFinancialControlsInsuranceClaimsInsuranceCompaniesProcessClaimsLossMedicaidDataEntryFraudClaimsCPTAuditMedicalRecordsDisabilitySpecialProjects

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Top Claims Analyst Skills

  1. Bank Procedures
  2. Provider Contracts
  3. Customer Service
You can check out examples of real life uses of top skills on resumes here:
  • Originate & investigate daily new & existing claims and ensuring they are in compliance with industry regulatory bank procedures.
  • Compared client s paid claims data to standard operating procedures, provider contracts and benefits administration.
  • Provide customer service and work with third party payers to resolve payment and denial issues.
  • Analyze disability insurance claims to determine eligibility and liability in accordance with policy provisions.
  • Conferred with insurance carriers, medical providers, attorneys and police personnel to make informed liability decisions.

Top Claims Analyst Employers

Claims Analyst Videos

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A Day in the Life -- Supply Chain

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