What does a senior claims analyst do?
Senior Claims Analysts are responsible for providing support and oversight on the process of liability claims. Their duties include verifying submitted claims, assessing reimbursement policies, performing reconciliation with claims estimates, and conducting payment negotiations. They manage claims processing costs, prepare payment documents, reclassify entries, and attend to requestors' queries. Senior Claims Analyst also organizes records and assist in providing mentorship and training sessions to junior staff.
Senior claims analyst responsibilities
Here are examples of responsibilities from real senior claims analyst resumes:
- Accomplish facets and Macess user including running reports.
- Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
- Coordinate the maintenance of TPA payment type / code table conversions data.
- Process claims, generate checks, create reports and correspond with TPA clients.
- Review claims for correct billing information such as correct CPT codes, ICD code and patient information.
- Analyze, evaluate, and conduct statistical data reviews as required by CMS in accordance with ZPIC policies.
- Communicate with other departments with the division to ensure the proper adjudication of claims according to CMS and plan guidelines.
- Coordinate benefits for multiple insurance plans, including Medicaid and Medicare.
- Follow company and carrier procedures for documentation of claim appeals handling and investigation.
- Review Medicare and Nebraska Medicaid claims to ensure accuracy prior to adjudication and payment.
- Review hospital and physicians' written appeals for additional payments and other administrative activities.
- Direct litigation in the areas of environmental liability, extra contractual claims, general liability, and medical malpractice.
- Research HCFA and UB claim edits to determine payment discrepancies and maintain acceptable levels of aging on all assign reviews.
- Research and development in all aspects of client's systems, health care provisions and HCFA relate claim laws.
- Detail knowledge of general claims processing principles, HCFA claims coding and UB-92-04 claims coding, which include all claim types.
Senior claims analyst skills and personality traits
We calculated that 7% of Senior Claims Analysts are proficient in Customer Service, Litigation, and Medical Terminology. They’re also known for soft skills such as Analytical skills, Detail oriented, and Interpersonal skills.
We break down the percentage of Senior Claims Analysts that have these skills listed on their resume here:
- Customer Service, 7%
Exceeded production and customer services satisfaction goals every month and received compensation each month since conception.
- Litigation, 7%
Directed litigation in the areas of environmental liability, extra contractual claims, general liability, and medical malpractice.
- Medical Terminology, 6%
Received CLMI designation for successfully completing classes and testing including Medical Terminology.
- Coverage Issues, 6%
Investigate and evaluate primary and excess layer environmental and bodily injury claims involving complex coverage issues.
- Policy Provisions, 5%
Develop and implement ongoing claim review strategy to ensure all policy provisions remain satisfied and financial integrity is maintained.
- Medicaid, 5%
Reviewed Medicare and Nebraska Medicaid claims to ensure accuracy prior to adjudication and payment.
Most senior claims analysts use their skills in "customer service," "litigation," and "medical terminology" to do their jobs. You can find more detail on essential senior claims analyst responsibilities here:
Analytical skills. To carry out their duties, the most important skill for a senior claims analyst to have is analytical skills. Their role and responsibilities require that "adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay." Senior claims analysts often use analytical skills in their day-to-day job, as shown by this real resume: "conducted multiple seminars for entire claims staff on topics of investigation, evaluation and litigation risk analysis. "
Detail oriented. Another soft skill that's essential for fulfilling senior claims analyst duties is detail oriented. The role rewards competence in this skill because "adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences." According to a senior claims analyst resume, here's how senior claims analysts can utilize detail oriented in their job responsibilities: "investigated, researched and analyzed claims data, applying knowledge of medical policies to determine detailed claim payment inaccuracies. "
Interpersonal skills. Another skill that relates to the job responsibilities of senior claims analysts is interpersonal skills. This skill is critical to many everyday senior claims analyst duties, as "adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering." This example from a resume shows how this skill is used: "demonstrate qualities such as decision-making, customer service, excellent communication, and interpersonal skills. "
Communication skills. senior claims analyst responsibilities often require "communication skills." The duties that rely on this skill are shown by the fact that "claims adjusters and investigators must get information from a range of people, including claimants, witnesses, and medical experts." This resume example shows what senior claims analysts do with communication skills on a typical day: "resolved claims issues submitted by customer relations and sales via internal communication system and telephone support. "
The three companies that hire the most senior claims analysts are:
- Zurich27 senior claims analysts jobs
- Bank of America8 senior claims analysts jobs
- XPO Logistics
6 senior claims analysts jobs
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Compare different senior claims analysts
Senior claims analyst vs. Adjuster
An adjuster is responsible for evaluating the extent of loss in the company by calculating the damage costs, determining the settlement payment to the client, and managing the reputation of the company for claims accountability. Adjusters must have extensive knowledge of the insurance principles and processes, following the state and federal regulations to protect clients and the business from insurance fraud. They collect documents from different organizations, perform field research, and interview witnesses to verify the accuracy of claims statement.
There are some key differences in the responsibilities of each position. For example, senior claims analyst responsibilities require skills like "medical terminology," "medicaid," "health insurance," and "property damage." Meanwhile a typical adjuster has skills in areas such as "strong customer service," "policy coverage," "auto claims," and "insurance coverage." This difference in skills reveals the differences in what each career does.
Adjusters earn the highest salaries when working in the insurance industry, with an average yearly salary of $50,894. On the other hand, senior claims analysts are paid more in the finance industry with an average salary of $99,363.adjusters tend to reach similar levels of education than senior claims analysts. In fact, adjusters are 2.3% less likely to graduate with a Master's Degree and 1.6% less likely to have a Doctoral Degree.Senior claims analyst vs. Insurance adjuster
An appraiser is someone who assesses the monetary value of a property such as an automobile, real property, and personal claim. His/Her or her responsibilities include resolving disparities between a property's monetary values and preparing narrative reports for projects. The essential skills that an appraiser should possess to accomplish such responsibilities include a keen eye for details, strong communication, analytical, and problem-solving skills, and the ability to work under pressure. The education requirements for the job vary depending on the area of focus.
In addition to the difference in salary, there are some other key differences worth noting. For example, senior claims analyst responsibilities are more likely to require skills like "litigation," "medical terminology," "policy provisions," and "medicaid." Meanwhile, an insurance adjuster has duties that require skills in areas such as "insurance policies," "auto claims," "catastrophe claims," and "public adjusters." These differences highlight just how different the day-to-day in each role looks.
Insurance adjusters earn a lower average salary than senior claims analysts. But insurance adjusters earn the highest pay in the insurance industry, with an average salary of $60,583. Additionally, senior claims analysts earn the highest salaries in the finance with average pay of $99,363 annually.insurance adjusters earn similar levels of education than senior claims analysts in general. They're 1.8% less likely to graduate with a Master's Degree and 1.6% less likely to earn a Doctoral Degree.What technology do you think will become more important and prevalent for senior claims analysts in the next 3-5 years?
Eduardo Zambrano
Professor of Economics, Orfalea College of Business
Senior claims analyst vs. Appraiser
A Claims Processor is responsible for processing and verifying insurance claims, in adherence to the policies, laws, and regulations of the company involved. Aside from examining its authenticity, they must also oversee new policies and recommend modifications should it be needed. Moreover, it is also the task of the Claims Processor to prepare the necessary documents and guidelines for the policyholder, process reimbursements upon approval, provide answers to inquiries, and report issues and updates to the management.
The required skills of the two careers differ considerably. For example, senior claims analysts are more likely to have skills like "medical terminology," "coverage issues," "policy provisions," and "medicaid." But a appraiser is more likely to have skills like "appraisal reports," "mai," "discounted cash flow," and "market research."
Appraisers earn the highest salary when working in the insurance industry, where they receive an average salary of $48,145. Comparatively, senior claims analysts have the highest earning potential in the finance industry, with an average salary of $99,363.appraisers typically earn similar educational levels compared to senior claims analysts. Specifically, they're 0.5% less likely to graduate with a Master's Degree, and 1.8% less likely to earn a Doctoral Degree.Senior claims analyst vs. Claim processor
Types of senior claims analyst
Updated January 8, 2025
