Senior Reporting Claims Analyst handling U.S. health insurance claims with focus on analysis and resolution. Collaborating with teams to ensure accurate claims processing and data-driven decision-making.
Responsibilities
Ensure accurate and timely resolution of insurance claims through careful review, investigation, and collaboration.
Review adjudicated claims for accuracy and compliance.
Evaluate claims processing policies, guidelines, and provider contracts.
Analyze historical overpayment trends and claims data to identify patterns or outliers.
Assess insurance claims to determine coverage, liability, and eligibility.
Confirm key claim details such as claim ID, date of service, refund amounts, and overpayment reasons.
Validate claim information in internal systems and match details against provided documentation.
Conduct thorough investigations, gathering all relevant documentation needed for resolution.
Work closely with internal teams and insurance adjusters to gather information and resolve issues.
Support team members as needed to ensure smooth project execution.
Calculate correct claim payments.
Maintain clear, organized records of claims, findings, and communications.
Track overpayment projects and ensure high-quality, timely updates.
Follow all client and company policies without exception.
Requirements
Good basic mathematics, reasoning, and interpretation skills
Working knowledge of MS Excel for project delivery
Expertise in U.S. Health Insurance Claims Processing
Excellent communication skills for client interaction
Bachelor’s degree or equivalent work experience
2–3 plus years experience in claims analysis or a related field
U.S. healthcare experience
Strong analytical and problem‑solving skills
Experience in reporting and data analysis
Proficiency with claims management software and tools
Knowledge of insurance regulations and industry best practices
Ability to work independently and collaboratively
High attention to detail and accuracy
Strong organizational and time management skills
Commitment to confidentiality and ethical standards
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