229 claims analyst jobs found

Claims Management Analyst Join us as a Claims Analyst to grow your experience in handling complex claims. Make your mark in Claims. Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency.  How you will create an impact Analyzing the scope and extent of coverage of primary policies with deductibles. Clear and concise written and verbal communication with insureds, TPAs, brokers and underwriters. Make regular and appropriate contact with internal and external customers including leading national Fortune 500 companies. Give guidance to insureds and/or brokers to manage expectations. Effectively strategize and...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity We are seeking a dedicated Workforce Management Analyst Senior to support the operational performance of the IT Service Desk and Internal Workforce Support organization through workforce planning, forecasting, scheduling, and capacity management. This role serves as a strategic partner to Service Desk leadership,...

As a Senior Analyst - Health and Benefits Consulting you will contribute to a wide variety of projects involving the design, financing and ongoing management of the full spectrum of health and benefit programs.   You will support the project manager on select projects, interface with vendors and key clients internally and externally, create client deliverables, and ensure quality standards are met.  You will have the opportunity to significantly grow your health and benefits business acumen as well as your financial, project management and client relationship skills by working on cutting edge projects alongside leaders in the industry. The Role Materially contribute to core health and benefits projects involving the design and management of group medical, dental, wellbeing, life, disability and absence management benefits for clients.  Responsibilities include:  Partnering with client service team leader to deliver superior project management   Providing superior client...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity Join our dynamic Reinsurance Operations team in the Life Actuarial department as a Reinsurance Analyst Senior! This is an exciting opportunity to play a vital role in leading reinsurance processes, from claims processing and treaty administration to financial reporting and audit support. You'll be responsible for managing...

Primary Role: The Employee Benefits Account Manager works collaboratively with the Producer, Account Executive and Account Administrator managing a book of business. Coordinates and provides day-to-day service for employee benefits clients by maintaining client relationships, supporting client retention, maintaining strong carrier relationships and understanding client needs. Serves as day-to-day contact and provides resolution for client questions and issues. Duties and Responsibilities: Maintains client relationships, supports client retention, maintains strong carrier relationships, and understands client needs. Collaborates on delivering multi-year strategic plan. Manages projects in concert with the client including, but not limited to, all vendor implementation. Provides benchmarking reports to client (annually, quarterly or monthly) Manages claims and coverage issue resolution for clients’ employees when elevated from HR. Provides assistance with...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to work independently...

Primary Role: The Employee Benefits Account Manager works collaboratively with the Producer, Account Executive and Account Administrator managing a book of business. Coordinates and provides day-to-day service for employee benefits clients by maintaining client relationships, supporting client retention, maintaining strong carrier relationships and understanding client needs. Serves as day to day contact and provides resolution for client questions and issues. Duties and Responsibilities: Maintains client relationships, supports client retention, maintains strong carrier relationships, and understands client needs Collaborates on delivering multi-year strategic plan Manages projects in concert with the client including, but not limited to, all vendor implementation Provides benchmarking reports to client (annually, quarterly or monthly) Manages claims and coverage issue resolution for clients’ employees when elevated from HR. Provides assistance with clients’ billing...

As a Health and Benefits Senior Analyst, you will contribute to a wide variety of projects involving the design, financing and ongoing management of the full spectrum of health and benefit programs.   You will support the  project manager on select projects, interface with vendors and key clients internally and externally, create client deliverables, and ensure quality standards are met.  You will have the opportunity to significantly grow your health and benefits business acumen as well as your financial, project management and client relationship skills by working on cutting edge projects alongside leaders in the industry. Responsibilities: Materially contribute to core health and benefits projects supporting the design and management of group medical, dental, wellbeing, life, disability and absence management benefits for clients. Responsibilities include: Partnering with client service team leader to deliver superior project management Providing...

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is seeking a Sr. Financial Consultant to join our growing team in Plano, TX!         Leads and oversees the servicing of financial consulting needs for employee benefit clients.   Utilizes industry knowledge and expertise to retain clients by providing financial, industry trends, and strategic insights guiding clients through impactful benefit changes.  Independently evaluates financial and utilization metrics for clients including but not limited to monthly financial reports, utilization metrics and benchmarks as well as assist in negotiating renewal proposals and preparing and recommending plan changes and/or alternative funding recommendations.       How You Will Contribute:     Oversight of monthly financial reports...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests.  This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned KNOWLEDGE & SKILLS: Ability to work...

Job Description: Job Summary:   As a Claims Intake Analyst, your positive can-do attitude is what makes you an asset. As a representative of Hallmark, you're the voice of the organization and may be the first interaction many of our callers have with us. Using your superior customer service skills, you'll assist our insured customers and agents with the reporting of a claim and other claim related claim questions and concerns. In this role, you may also complete claim processing functions for new and existing claims, answer emails, or assist agents and customers. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience High school diploma or GED required, with...

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency:  English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: The Carrier & Facility Reporting Manager is a highly visible leadership role within CRC Group’s Risk Solutions team, responsible for the accurate, consistent, and timely delivery of carrier and facility-level reporting across CRC’s proprietary capacity vehicles and external capital partner relationships. This role leads a team of Operations Analysts and serves as the functional reporting lead...

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies....

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies....

As one of the leading writers of Federal Crop Insurance, AgriSompo North America combines industry experience, resources, capital and talent to deliver both traditional and innovative crop insurance and productivity tools to farmers, ranchers, insurers and agribusinesses in the United States. Our organization operates within a culture rooted in ethics, integrity and a belief that accountability, collaboration and agility are crucial to long-term success.  AgriSompo North America is a part of AgriSompo, Sompo International’s global agriculture platform. This platform is an integrated underwriting, technology and distribution platform delivering innovate insurance and reinsurance solutions to agriculture partners worldwide.  Sompo International, AgriSompo’s parent company, is a global organization driven by its core values, a carrier that holds promise, trust and the commitment to protect.  Through operating subsidiaries, Sompo International writes agriculture, casualty and...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity Relocation assistance is available for this position. We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position can be based in one of the following locations: San Antonio, TX, Plano, TX, Phoenix, AZ, Colorado Springs, CO, Charlotte, NC, or Tampa, FL. This...

The Repricing Quality Assurance Analyst is responsible for reviewing, analyzing, and monitoring repricing audit data across multiple platforms to ensure accuracy, compliance, and efficiency. Works closely with internal teams to maintain contractual and organizational standards, enhance operational effectiveness, and improve client satisfaction. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify and resolve quality issues within repricing processes Develop and implement QA policies and procedures Monitor compliance with pricing guidelines and contractual requirements Investigate repricing discrepancies and apply corrective actions Prepare QA reports and documentation Collaborate with stakeholders to align quality objectives Provide training and guidance on repricing standards Conduct risk assessments to mitigate potential errors Maintain confidentiality of client data, PHI, and PII Additional duties as assigned...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and analytical skills for...