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Claims analyst skills for your resume and career

Updated January 8, 2025
4 min read
Quoted expert
David Feldman Ph.D.
Claims analyst example skills
Below we've compiled a list of the most critical claims analyst skills. We ranked the top skills for claims analysts based on the percentage of resumes they appeared on. For example, 14.3% of claims analyst resumes contained customer service as a skill. Continue reading to find out what skills a claims analyst needs to be successful in the workplace.

15 claims analyst skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how claims analysts use customer service:
  • Implement and facilitate strategies to review for errors to inform customer service and Underwriter for planned communication and origination completion.
  • Provided exceptional customer service to communicate claims decisions and technical information directly to clients and claimants orally and in writing.

2. Medical Terminology

Here's how claims analysts use medical terminology:
  • Research of financial and medical terminology as well as financial documents and pharmaceuticals.
  • Use of medical terminology and medical law/policy was needed daily.

3. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how claims analysts use cpt:
  • Utilized claim systems to obtain and record claim information with ICD9 & CPT coding, reviewing to make claim payment decisions.
  • Maintained a working knowledge of CPT and ICD-9 codes; Worked closely with South Carolina Workers Compensation Commission and Medicare guidelines.

4. Process Claims

Process claims refers to the procedure an insurance agent follows once receiving a claim from an insured individual. This often includes reviewing, investigating, and deciding on whether the claim will be accepted or denied depending on the results of the insurer's investigation. This is a common procedure for all kinds of insurance including medical, auto, and liability insurance.

Here's how claims analysts use process claims:
  • Process claims/verify authorization requirements/coordinate benefits/follow mandates.
  • Exceeded established productivity and quality goals; monitor inventory aging to select and process claims within established time frames.

5. Medicaid

Here's how claims analysts use medicaid:
  • Provided excellent customer service by reviewing Medicaid/Medicare Liens, determining auto liability, processing checks/payments/settlements/lost time from work/ worker's comp.
  • Processed Medicare enrollment application during open enrollment periods following guidelines set by Center for Medicare and Medicaid Services.

6. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how claims analysts use data entry:
  • Performed data entry which entailed working with highly sensitive military information, military claims into computer system.
  • Operated various data entry terminals and automated data systems to record and verify billing accounts receivable information.

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7. Health Insurance

Here's how claims analysts use health insurance:
  • Reviewed claims related to additional health insurance to ensure proper coordination of benefits and payments.
  • Researched and monitored outstanding health insurance claim denials within time and quality assurance standards.

8. Bank Procedures

Here's how claims analysts use bank procedures:
  • Maintained compliance with industry regulations and bank procedures.
  • Updated customers regarding pending and denied claims and gathered information needed for claim to be resolved following bank procedures and policies.

9. Medical Claims

Here's how claims analysts use medical claims:
  • Managed the submission, payment reconciliation and adjudication of all medical claims during participation in the experimental Monroe Country MediCap program.
  • Processed routine medical and prescription payments and status reports for lifetime medical claims and/or defined period medical claims.

10. Claims Issues

Here's how claims analysts use claims issues:
  • Demonstrated superior skill in addressing provider issues/inquires, regarding benefit, member eligibility, and all provider claims issues.
  • Resolved claims issues aroused by Customer Relations via internal communication system and telephone support.

11. Quality Standards

Quality standards are a specific level of standards of products that are set by the companies for the customers that have to be met and maintained throughout the process until the time of delivery. Quality standards are information that includes the customer's requirements, guidelines, and characteristics for the needed final product or service.

Here's how claims analysts use quality standards:
  • Negotiate optimal claim resolution while maintaining full compliance with internal and external quality standards and state specific regulations.
  • Home processor-worked independently while maintaining and exceeding production and quality standards in processing medical and hospital claims.

12. HCPCS

Here's how claims analysts use hcpcs:
  • Research claims for correct processing of ICD-9-CM, CPT-4, HCPCS and modifiers.
  • Review hcpcs code to ensure accurate payment.

13. Medical Billing

Here's how claims analysts use medical billing:
  • Verified medical providers' addresses and tax information in compliance with medical billing regulations.
  • Communicated effectively with a variety of providers to obtain relevant medical billing information.

14. Insurance Claims

Here's how claims analysts use insurance claims:
  • Support escalations and issue resolution related to the accurate processing of mortgage insurance claims and expense reimbursement requests.
  • Obtain information required to effectively evaluate claim decisions regarding the acceptance or denial of travel insurance claims.

15. Computer System

Here's how claims analysts use computer system:
  • Authored training materials and operational procedure guide on company's computer system applications.
  • Input statistical information and other data into computer system.
top-skills

What skills help Claims Analysts find jobs?

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What skills stand out on claims analyst resumes?

David Feldman Ph.D.

Professor of Urban Planning and Public Policy and Political Science, Director, Water UCI, Director, MPP Program, University of California, Irvine

Succinct writing, critical thinking, strong quantitative analytical skills.
Do you want to know more?
Read more about what experts have to say about claims analyst

List of claims analyst skills to add to your resume

The most important skills for a claims analyst resume and required skills for a claims analyst to have include:

  • Customer Service
  • Medical Terminology
  • CPT
  • Process Claims
  • Medicaid
  • Data Entry
  • Health Insurance
  • Bank Procedures
  • Medical Claims
  • Claims Issues
  • Quality Standards
  • HCPCS
  • Medical Billing
  • Insurance Claims
  • Computer System
  • ICD-9
  • HIPAA
  • Insurance Coverage
  • CMS
  • COB
  • Fraud Claims
  • Outbound Calls
  • Disability Claims
  • TPA
  • Insurance Carriers
  • Dental Claims
  • Fee Schedules
  • Hippa
  • Policy Provisions
  • HMO
  • Diagnosis Codes
  • PPO
  • Claims Handling
  • Pending Claims
  • EOB
  • EDI
  • Facets
  • Defense Counsel
  • Debit Cards
  • Customer Claims
  • Inbound Calls
  • Claims Data
  • ACH
  • Management System
  • Customer Accounts
  • Compensation Claims
  • ATM
  • Hospital Claims
  • Medical Necessity
  • HCFA

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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