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Medical Claims Analyst Job Description

What does a Medical Claims Analyst do?

A Medical Claims Analyst is responsible for reviewing medical claims submitted by patients, verifying their authenticity, and determining whether they are eligible for reimbursement. They cross-reference medical records and billing information to ensure that everything is correct and that the patient has received the appropriate care. They work with insurance providers and healthcare professionals to resolve any issues that arise during the claims process. Medical Claims Analysts must have an understanding of medical terminology, billing procedures and insurance policies. They also need to have excellent communication and organizational skills to manage a high volume of claims efficiently.

Our Medical Claims Analyst job description includes the Medical Claims Analyst responsibilities, duties, skills, education, qualifications, and experience.

Medical Claims Analyst Example

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If you need an example job description for a Medical Claims Analyst download the one below, alternatively we have many other Banking and Insurance job description samples and a job description library with over 3000 job descriptions templates that you can download for free.

What does a Medical Claims Analyst do?

A Medical Claims Analyst is responsible for ensuring that medical claims are processed accurately and in a timely manner. They are responsible for reviewing submitted claims for accuracy, completeness and compliance with company policies and procedures. They also analyze claims data to discover patterns of improper payments and identify potential fraud. They also provide reports and analysis to management, as well as provide technical support and training to staff on claims processing.

Medical Claims Analyst Role Purpose

The purpose of a Medical Claims Analyst is to provide accurate and timely analysis of medical claims data in order to reduce costs and improve the efficiency of the organisation's medical claims processes. This role involves reviewing medical claims for accuracy and completeness, researching discrepancies and determining the appropriate course of action, determining the best practices for submission of claims, and providing insights and recommendations to management. The analyst must also ensure that all applicable laws and regulations have been followed and that the organisation is compliant.

Medical Claims Analyst Role

A Medical Claims Analyst is responsible for reviewing and evaluating medical claims submitted by healthcare providers and ensuring they meet the necessary requirements to be reimbursed. They must also investigate any discrepancies or inaccuracies in the submitted claims, and provide accurate feedback to healthcare providers. The analyst must also be knowledgeable about medical coding and insurance claims regulations.

Medical Claims Analyst Duties

  • Evaluate medical claims for accuracy and completeness
  • Analyse claim data to identify trends and root causes of claim errors
  • Verify diagnosis codes and procedure codes according to established protocols
  • Assess medical claims to ensure adherence to company policies and regulations
  • Provide feedback to providers on claim errors

Medical Claims Analyst Requirements

  • Analyse medical claims data
  • Identify and investigate any discrepancies in claims
  • Work with other departments to ensure accuracy of claims
  • Provide monthly reports to management

Medical Claims Analyst Skills

  • Data Analysis
  • Organizational Skills
  • Interpersonal Skills
  • Excellent Attention to Detail

Medical Claims Analyst Personal Traits

  • Strong analytical skills
  • Attention to detail
  • Excellent communication and interpersonal skills
  • Organised and able to work to deadlines

How to write a Medical Claims Analyst Job Advert

Use our job advert template to write a job advert for posting on job sites and job boards. Our job advertising templates are carefully created to help you reach your audience and beat the competition to the best talent.

A job description informs the reader about a job, whereas a job advert’s main objective is to sell the job opportunity to attract as many suitable applicants possible. A job advert maybe the first touch-point a candidate has with your company so it is important to create a great impression.

Job Advertisements should enticing, so considering using short, exciting language which get the reader’s attention.

How to write a Medical Claims Analyst Job Description

To write a job description, we recommend starting with a job description template from our job description library, which contains examples for 800+ positions and professions. Our job description examples include a job summary with duties and responsibilities and skills and requirements, which can be personalised for your job vacancy.

Job Description Advice - Guidance on How to Personalise a Medical Claims Analyst Job Specification

The hiring process and recruiting new employees to fill your key roles requires a degree of personalisation if you are to attract the best employees in a competitive employment market. The right person for a crucial role or more senior roles will likely have other employers targeting them. As your job description will be the first point of contact, you need to nail your pitch and provide the best possible service.

Job Description Tips - Help on formatting a Medical Claims Analyst Job Specification

When creating your bespoke description and advert, you should cover and promote these points:

Job title: This should accurately reflect the role and include keywords that top talent might be using to search for jobs.

Job duties: The day to day duties, such as administrative tasks, which vary depending on the company and inform the candidate if they can complete the role.

Technical skills: These are the hard skills required through training, such as proficiency with Microsoft Office.

Soft skills: These include the interpersonal skills and general abilities the right candidates will possess. For example, the competency to prioritise multiple tasks, handle customer queries and customer complaints, work alone, or build a good relationship with coworkers.

The company's culture: Highlighting your company culture and values ensures employees thrive and find outstanding job satisfaction. Candidates that are not the right fit won’t waste their time completing the application process, meaning you can focus on qualified individuals and hire in a more timely manner.

Career progression: Including the career path will entice candidates looking for career growth. 

Training and development programs: Smaller companies may need employees with previous experience or provide educational assistance over internal training offered by larger organisations with more significant resources. 

Employee benefits: Compensation and benefits often fail to appear in job ads and while you may want to hold your cards close to your chest, failing to include them is a mistake. Consider answering common questions, such as working hours and paid leave. Researching the average salary for the role in these early stages will ensure you don’t waste your interviewer’s and the candidate’s time.

Skill gaps: Your company may need to bring in new skills beyond those required to complete the key role and duties. Thinking on an organisational level can be beneficial when contemplating skills diversity.

Legal requirements: Ensure your job advert and description does not ask for inappropriate or discriminatory personal details, such as age, marital status, or religion.

How to Hire a Medical Claims Analyst

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