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Medical claims analyst skills for your resume and career

Updated January 8, 2025

5 min read

Quoted expert

Jill Bisco Ph.D., CIC, CRM, CPRM, CSRM

Below we've compiled a list of the most critical medical claims analyst skills. We ranked the top skills for medical claims analysts based on the percentage of resumes they appeared on. For example, 9.5% of medical claims analyst resumes contained medical terminology as a skill. Continue reading to find out what skills a medical claims analyst needs to be successful in the workplace.

15 medical claims analyst skills for your resume and career

1. Medical Terminology

Here's how medical claims analysts use medical terminology:

Evaluated medical claims utilizing medical terminology.
Developed expertise in medical terminology.

2. Medicaid

Here's how medical claims analysts use medicaid:

Interpret Manage Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collections.
Processed Behavioral Health, Medicaid and Commercial HMO professional and institutional outpatient claims.

3. Medical Insurance Claims

Here's how medical claims analysts use medical insurance claims:

Processed medical insurance claims as a third party administrator.
Processed medical insurance claims electronically.

4. 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 medical claims analysts use customer service:

Provided customer service for claims and maintained very high quality and productivity goals
Worked closely with customer service to reprocess claims originally processed incorrectly.

5. 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 medical claims analysts use data entry:

Performed data entry of medical claims according to state regulations or usual and customary guide lines
Managed and developed the Dental Claims Department and dental data entry team members.

6. Patients

Here's how medical claims analysts use patients:

Reviewed primary care physician referrals to direct patients to their approved specialists.
Interacted with patients over the phone regarding payment follow-ups and eligibility status.

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7. Medical Billing

Here's how medical claims analysts use medical billing:

Reviewed medical billings for reasonableness of tests, procedures, and hospital stays.
Coordinated efforts of approximately 10 medical billing clerks to increase revenue for clients.

8. Health Insurance

Here's how medical claims analysts use health insurance:

Determine primacy of coverage for beneficiary and the health insurance company.
Processed medical claims according to health insurance procedures and regulations.

9. Medical Treatment

Here's how medical claims analysts use medical treatment:

Review medical treatment records, medical bills, or physical bodily damage to determine the extent of liability.
Assisted and advised claims examiners concerning the monitoring of claimants' medical treatments.

10. ICD-9

Here's how medical claims analysts use icd-9:

Analyzed incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
Reviewed medical records to determine if the ICD-9, CPT codes and modifiers were processed correctly.

11. TPA

Here's how medical claims analysts use tpa:

Place multiple phone calls to TPA, Medicare and Dialysis Centers to request medical records, claims and verify treatment/medication regimens.
Determined whether members had additional medical coverage and coordinates claims processing with other carriers and TPA s as necessary.

12. CMS

A Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.

Here's how medical claims analysts use cms:

Provide utilization management support to CMS and SGS investigators with respect to Medicare Fraud, Waste and Abuse related issues.
Audited new hire and experienced claims processor associate claims, providing feedback and assuring claims were processed according to CMS guidelines.

13. Appeals

Here's how medical claims analysts use appeals:

Worked in Utilization Management completing medical documentation review for claims, appeals, retrospective reviews and provider complaints.
Monitored and verified reimbursements are paid accurately and timely Confidently and adeptly handled claim denials and/or appeals.

14. CPT-4

Here's how medical claims analysts use cpt-4:

Used CPT-4 code for medical procedures and service, also coding and collections.
Applied knowledge of ICD-9CM, ICD-10CM and CPT-4 coding in order to determine services rendered.

15. HIPAA

Here's how medical claims analysts use hipaa:

Adhered to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
Uphold state, federal and HIPAA laws and guidelines with regard to patient records and collections.

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What skills help Medical Claims Analysts find jobs?

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What medical claims analyst skills would you recommend for someone trying to advance their career?

Jill Bisco Ph.D., CIC, CRM, CPRM, CSRM

Assistant Professor of Risk Management and Insurance, Website

I believe that everyone in the industry will need to have a comfort with technology and, depending on the position, the ability to analyze data. As we see artificial intelligence, things change quickly and how the business operates today will change in the coming years. One doesn’t have to be an instant master of new technology, but knowing what is available and how it is being used will allow those in the industry the opportunity to engage in discussions of future innovations.

It may seem like a cliché, but “thinking outside the box” is still an important skill in insurance. With so many changes occurring in the world (weather, unrest, economic issues, etc.), it is a skill to be able to look at situations and think of new or innovative ways to address them. Don’t be afraid to share a new idea or question a current way of doing things. You never know where the next big idea will come from

Do you want to know more?

List of medical claims analyst skills to add to your resume

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

Medical Terminology
Medicaid
Medical Insurance Claims
Customer Service
Data Entry
Patients
Medical Billing
Health Insurance
Medical Treatment
ICD-9
TPA
CMS
Appeals
CPT-4
HIPAA
Medical Reports
Process Claims

HCPCS
Ub-04
Medical Benefits
Medical Necessity
Provider Contracts
Medical Review
Medical Management
Hospital Claims
Patient Accounts
EOB
HMO
Claims Data
Hippa
Insurance Carriers
COB
Quality Standards
PPO

DME
Telephone Calls
A/R
HCFA
EDI
Dental Claims
Billing Issues
Medical Services
Computer System
Ub04
Fee Schedules
Facets
Physical Therapy
Insurance Coverage
Unpaid Claims
Billing System

Updated January 8, 2025

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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