Medical Claims Analyst Job Description and Profile

The medical claims analyst work in health insurance or government organizations to ensure that the claims received are valid. He or she determines whether the insurance company will make the claimed payment to the doctors or the hospitals. The medical claim analyst reviews the medical bills for the accuracy of the treatments, tests, and hospital stays prior to sanctioning the claims. In case there are any queries, the analyst collects additional documents and conducts further investigation. He or she is responsible for identifying inaccuracies in claims that have been paid while working with third-party billing agencies to resolve discrepancies.

Medical Claims Analyst Duties and Responsibilities

  • Reviewing billing information to check for accuracy and correctness
  • Investigate further in case of discrepancy of information
  • Verifying the documentation and other documentation provided by the claimant
  • Knowledgeable about medical terms, practices, and pharmaceuticals
  • Settling claims in accordance to company rules and regulations
  • Conferring with the legal counsels on claims that require litigation

Medical Claims Analyst Education, Training, and Qualifications

A majority of the employers requires an individual to possess a bachelor degree in nursing or any other medical related field. In case, a person aspires to work as a medical claims analyst with an insurance company, prior experience in claims adjustments is necessary. A degree in physician assistant or pharmacy is also preferred by some employers that hire medical claims analyst. Some experience in reviewing, authorizing, and monitoring medical services is an added benefit to succeed as a medical claims analyst.

Medical Claims Analyst Degrees, Courses, and Certification

A bachelor’s degree in nursing, pharmacy, or physician assistant is necessary for a medical claims analyst profile. Courses providing training on working with automated reviewing and data analysis systems are preferable. Furthermore, completing a course that provides knowledge of the various health care standards is beneficial. Knowledge on billing procedures and standards is beneficial. Any other course that imparts training on workers compensation, report making, effective communication, and working with legal counsels are preferred by employers.

Medical Claims Analyst Skills and Specifications

  • Analyze and resolve health service related claims
  • Maintain confidentially with sensitive information
  • Understanding the claims settlement procedures and guidelines
  • Knowledge on workers disability compensation standards
  • Working with data analysis tools
  • Interviewing skills with health care providers, technical persons, and health care beneficiaries
  • Maintaining records and corresponding with several agencies

Medical Claims Analyst Salary

The average salary paid to a medical claims analyst is between $31000 per year to $60000 per annum.