Medical claims analyst job description
Updated March 14, 2024
8 min read
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Example medical claims analyst requirements on a job description
Medical claims analyst requirements can be divided into technical requirements and required soft skills. The lists below show the most common requirements included in medical claims analyst job postings.
Sample medical claims analyst requirements
- Bachelor's Degree in Healthcare Administration or related field.
- Certified Professional Coder (CPC) certification.
- At least 2 years of experience in Medical Billing.
- Knowledge and experience with ICD-10, HCPCS and CPT coding.
- Proficiency in MS Office applications.
Sample required medical claims analyst soft skills
- Excellent communication skills.
- Strong attention to detail.
- Ability to work independently.
- Excellent problem-solving skills.
- Strong organizational skills.
Medical claims analyst job description example 1
Dane Street medical claims analyst job description
Dane Street is looking for highly motivated candidates to join our National IME (Independent Medical Examination) as a
Claims Quality Analyst (internally known as Quality Analyst). Dane Street is proud to be Great Place to Work-Certified and offers an exciting work environment, competitive compensation and a strong growth potential.
A Quality Analyst is in the center of our critical relationships with our clients, our technical team and our operations teams. As a member of our team, you will be responsible for reviewing IME and Peer Review reports for accuracy.
Do you thrive in a fast paced environment? You are the right person if you have exceptional communication skills, display attention to details, the ability to apply critical thinking and are able to manage time effectively while meeting specific deadlines.
Description of Key Tasks and Responsibilities:
Reviews reports accompanying medical records to ensure that the report is complete and that all questions posed have been addressed. Follows up with the reviewer and clients with any additional questions or need clarification. Evaluate physician specialty assignment and guidelines application based on guidelines or assist in the analysis of IME cases. Communicate inconsistencies and/or inaccuracies based on medical documentation and/or state guidelines. Follows up with IME/Peer Review provider to ensure that the report is received back for QA within the specified time-line set forth by the referrer. Improve team's competence by providing resources; balancing file requirements within the client specifications all within company procedures and guidelines.
Requirements
Required Education and Experience:
An Associate's Degree or Bachelor's Degree is preferred. Lost Time Workers Compensation claims experience is preferred. Previous experience with peer review/case management is preferred. Experience as a claims adjuster within the insurance/medical industry, auto, worker's compensation, nursing (LPNs or RNs) or work with an IME company a plus.
Special Skills and Attributes:
Ability and confidence to speak with physicians and clients regarding the content of their medical peer reviews. Claims/Medical Terminology background. Ability to learn quickly. Ability to research and document clearly is essential to the success of this position. Excellent computer skills are required. Excellent organizational skills are essential, including the ability to manage time efficiently and to meet specific deadlines. Excellent communication and grammar skills are a must. The ability to work independently and make critical decisions is essential.
Benefits
We offer generous Paid Time Off, excellent benefits package and a competitive salary. Apple equipment and media stipend is provided for remote work space. Come up to speed quickly with our strong training program! If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
Claims Quality Analyst (internally known as Quality Analyst). Dane Street is proud to be Great Place to Work-Certified and offers an exciting work environment, competitive compensation and a strong growth potential.
A Quality Analyst is in the center of our critical relationships with our clients, our technical team and our operations teams. As a member of our team, you will be responsible for reviewing IME and Peer Review reports for accuracy.
Do you thrive in a fast paced environment? You are the right person if you have exceptional communication skills, display attention to details, the ability to apply critical thinking and are able to manage time effectively while meeting specific deadlines.
Description of Key Tasks and Responsibilities:
Reviews reports accompanying medical records to ensure that the report is complete and that all questions posed have been addressed. Follows up with the reviewer and clients with any additional questions or need clarification. Evaluate physician specialty assignment and guidelines application based on guidelines or assist in the analysis of IME cases. Communicate inconsistencies and/or inaccuracies based on medical documentation and/or state guidelines. Follows up with IME/Peer Review provider to ensure that the report is received back for QA within the specified time-line set forth by the referrer. Improve team's competence by providing resources; balancing file requirements within the client specifications all within company procedures and guidelines.
Requirements
Required Education and Experience:
An Associate's Degree or Bachelor's Degree is preferred. Lost Time Workers Compensation claims experience is preferred. Previous experience with peer review/case management is preferred. Experience as a claims adjuster within the insurance/medical industry, auto, worker's compensation, nursing (LPNs or RNs) or work with an IME company a plus.
Special Skills and Attributes:
Ability and confidence to speak with physicians and clients regarding the content of their medical peer reviews. Claims/Medical Terminology background. Ability to learn quickly. Ability to research and document clearly is essential to the success of this position. Excellent computer skills are required. Excellent organizational skills are essential, including the ability to manage time efficiently and to meet specific deadlines. Excellent communication and grammar skills are a must. The ability to work independently and make critical decisions is essential.
Benefits
We offer generous Paid Time Off, excellent benefits package and a competitive salary. Apple equipment and media stipend is provided for remote work space. Come up to speed quickly with our strong training program! If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
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Medical claims analyst job description example 2
Veeva Systems medical claims analyst job description
Veeva is a mission-driven organization that aspires to help our customers in Life Sciences and Regulated industries bring their products to market, faster. We are shaped by our values: Do the Right Thing, Customer Success, Employee Success, and Speed. Our teams develop transformative cloud software, services, consulting, and data to make our customers more efficient and effective in everything they do. Veeva is a work anywhere company. You can work at home, at a customer site, or in an office on any given day. As a Public Benefit Corporation, you will also work for a company focused on making a positive impact on its customers, employees, and communities.
The Role
Veeva Link envisions building connected data applications to improve research and patient outcomes. We are looking for a claims analyst who would be interested in building out our claims database.
As a major part of our Key People Agile operations team, you will be the subject matter expert for questions regarding the claims data structure, scores, and quality. You will make sure the data we use meet the product goal and provide valuable insights for our customers across the world. You will be closely working with product management, data operations, data governance, software engineering, and quality assurance teams.
To thrive in your role, you need to have experience with ICD10 codes and pharmacy claims data. Initial working experience with data analytics, large databases, and complex data sets is also required. You are a fast learner, detail-oriented, have a growth mindset, and can turn data into valuable insights. You communicate effectively with stakeholders and can deliver high-quality results within challenging timelines. You are comfortable working remotely in an international environment.
We care about a great cultural fit. You should enjoy working at speed in multi-cultural teams. If you are excited about data, Life Sciences, and working for a fast-growing tech company, apply now!
What You'll DoDevelop new claims scores for 50-100 new diseases Assure that data quality meets our high standards Analyze large data sets and generate insights Map ICD-10 codes from multiple implementations (e.g., WHO, GM, CM) to Link topics Provide lists of FDA-approved drugs for new diseases, and whether the drugs are approved for multiple indications Provide analytics on the community leader universe (US and EU) Identify high claims volume HCPs, HCOs, and departments to develop a list of KOLs to add to our product Map out specialties to diseases per country for all relevant community leader diseases (US & EU)
Requirements1+ years of experience analyzing US or EU Claims data Experience mapping ICD10 codes (e.g. to internally defined therapeutic areas and diseases) Database extraction (Advanced SQL) Experience working with large databases and data sets Confident spreadsheets user (pivot tables, nested formulas) Strong written and verbal communication skills in English
Perks & BenefitsOpportunity to work in a diverse and international workspace Personal development budget Charity budgetA significant contribution to the pension fund Life insurance Fitness reimbursement
#RemoteGermany
Veeva's headquarters is located in the San Francisco Bay Area with offices in more than 15 countries around the world.
Veeva is committed to fostering a culture of inclusion and growing a diverse workforce. Diversity makes us stronger. It comes in many forms. Gender, race, ethnicity, religion, politics, sexual orientation, age, disability and life experience shape us all into unique individuals. We value people for the individuals they are and the contributions they can bring to our teams.
The Role
Veeva Link envisions building connected data applications to improve research and patient outcomes. We are looking for a claims analyst who would be interested in building out our claims database.
As a major part of our Key People Agile operations team, you will be the subject matter expert for questions regarding the claims data structure, scores, and quality. You will make sure the data we use meet the product goal and provide valuable insights for our customers across the world. You will be closely working with product management, data operations, data governance, software engineering, and quality assurance teams.
To thrive in your role, you need to have experience with ICD10 codes and pharmacy claims data. Initial working experience with data analytics, large databases, and complex data sets is also required. You are a fast learner, detail-oriented, have a growth mindset, and can turn data into valuable insights. You communicate effectively with stakeholders and can deliver high-quality results within challenging timelines. You are comfortable working remotely in an international environment.
We care about a great cultural fit. You should enjoy working at speed in multi-cultural teams. If you are excited about data, Life Sciences, and working for a fast-growing tech company, apply now!
What You'll DoDevelop new claims scores for 50-100 new diseases Assure that data quality meets our high standards Analyze large data sets and generate insights Map ICD-10 codes from multiple implementations (e.g., WHO, GM, CM) to Link topics Provide lists of FDA-approved drugs for new diseases, and whether the drugs are approved for multiple indications Provide analytics on the community leader universe (US and EU) Identify high claims volume HCPs, HCOs, and departments to develop a list of KOLs to add to our product Map out specialties to diseases per country for all relevant community leader diseases (US & EU)
Requirements1+ years of experience analyzing US or EU Claims data Experience mapping ICD10 codes (e.g. to internally defined therapeutic areas and diseases) Database extraction (Advanced SQL) Experience working with large databases and data sets Confident spreadsheets user (pivot tables, nested formulas) Strong written and verbal communication skills in English
Perks & BenefitsOpportunity to work in a diverse and international workspace Personal development budget Charity budgetA significant contribution to the pension fund Life insurance Fitness reimbursement
#RemoteGermany
Veeva's headquarters is located in the San Francisco Bay Area with offices in more than 15 countries around the world.
Veeva is committed to fostering a culture of inclusion and growing a diverse workforce. Diversity makes us stronger. It comes in many forms. Gender, race, ethnicity, religion, politics, sexual orientation, age, disability and life experience shape us all into unique individuals. We value people for the individuals they are and the contributions they can bring to our teams.
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Medical claims analyst job description example 3
Nevada Health Centers medical claims analyst job description
The Junior Medical Claims/Data Analyst is responsible for performing complex healthcare-related data analysis. This role is responsible for learning and understanding the complexities of the organization's database and the functions of the various departments to interpret and make recommendations using the data in review.
*Job Duties and Responsibilities (but not limited to): *
*
* Maintained and update contracts and rates in both database and binders.
* Prepare and comply with monthly reports required by Insurance Companies and verify completeness and accuracy.
* Maintain or modify all existing financial analytic models.
* Enter data into billing and accounting software for use in analyses and reports.
* Compile reports, charts, or graphs that describe and interpret the findings of analyses.
* Gather data from different sources to create or recreate a report and analysis. It involves communicating with internal and external personnel.
* Provide application support to billing, accounting, compliance, and other departments, especially for an urgent analytical projects.
* Research and develop mathematical and financial tools, performance measurement, attribution, and models.
* Review, evaluate and investigate claims data carefully and thoroughly compared to contracts and prepare monthly dispute reports.
* Other duties as assigned.
*Job Requirements: *
* Advanced PC skills, including Microsoft Word, Excel, Access, and Outlook skills PowerPoint experience preferred
* Experience with statistical tools to interpret data sets, paying particular attention to trends and patterns that could be valuable for diagnostic and predictive analytics efforts
* Excellent written and verbal communication skills
* Must be well organized and detail-oriented with demonstrated effective time-management
* Must have the ability to work independently and within a team environment
* Ability to meet deadlines
* Exercise clear and concise judgment, decision-making, and problem-solving skills
*Preferred: *
* Knowledge of medical codes, medical claims, claims processes, and procedures.
*Education Requirements: *
* Bachelor's Degree in actuary science, accounting, finance, mathematics, statistics, health care administration, or business administration
* An equivalent combination of education, certification, training and/or professional experience may be used to meet the minimum education qualifications
Nevada Behavioral Health Systems is proud to be an Equal Opportunity Employer!
Job Type: Full-time
Pay: $60,000.00 - $80,000.00 per hour
Schedule:
* Monday to Friday
Application Question(s):
* Will you now, or in the future, require sponsorship for employment visa status (e.g. H-1B visa status)?
Work Location: One location
*Job Duties and Responsibilities (but not limited to): *
*
* Maintained and update contracts and rates in both database and binders.
* Prepare and comply with monthly reports required by Insurance Companies and verify completeness and accuracy.
* Maintain or modify all existing financial analytic models.
* Enter data into billing and accounting software for use in analyses and reports.
* Compile reports, charts, or graphs that describe and interpret the findings of analyses.
* Gather data from different sources to create or recreate a report and analysis. It involves communicating with internal and external personnel.
* Provide application support to billing, accounting, compliance, and other departments, especially for an urgent analytical projects.
* Research and develop mathematical and financial tools, performance measurement, attribution, and models.
* Review, evaluate and investigate claims data carefully and thoroughly compared to contracts and prepare monthly dispute reports.
* Other duties as assigned.
*Job Requirements: *
* Advanced PC skills, including Microsoft Word, Excel, Access, and Outlook skills PowerPoint experience preferred
* Experience with statistical tools to interpret data sets, paying particular attention to trends and patterns that could be valuable for diagnostic and predictive analytics efforts
* Excellent written and verbal communication skills
* Must be well organized and detail-oriented with demonstrated effective time-management
* Must have the ability to work independently and within a team environment
* Ability to meet deadlines
* Exercise clear and concise judgment, decision-making, and problem-solving skills
*Preferred: *
* Knowledge of medical codes, medical claims, claims processes, and procedures.
*Education Requirements: *
* Bachelor's Degree in actuary science, accounting, finance, mathematics, statistics, health care administration, or business administration
* An equivalent combination of education, certification, training and/or professional experience may be used to meet the minimum education qualifications
Nevada Behavioral Health Systems is proud to be an Equal Opportunity Employer!
Job Type: Full-time
Pay: $60,000.00 - $80,000.00 per hour
Schedule:
* Monday to Friday
Application Question(s):
* Will you now, or in the future, require sponsorship for employment visa status (e.g. H-1B visa status)?
Work Location: One location
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Updated March 14, 2024
Updated March 14, 2024