Claims Analyst

Position Overview

The position’s primary focus is responsible for claims processing including, but not limited to, processing incoming Medical and Dental claims received by clients, utilizing multiple fee schedules, online re-pricing and forwarding to the appropriate network according to network participation.

The Claims Analyst works with the Network Management and Client Services teams

Key Responsibilities :

• Maintains HIPAA guidelines within business units.


• Communicates with networks in follow-up of outstanding claim repricing’s.


• Analyzes claim routing discrepancies and determines where a claim should route based on specific client and / or / network parameters.


• Coordinates repricing and re-routing of claims by assigning networks while maintaining qualitative and quantitative standards.


• Completes revisions to repriced claims as requested by Client Services.



• Maintains the policies and procedures of the Buddy Program .


• Identifies system issues (C2K, Client Portal, Med Engine, etc.), gather examples and submit ISSR for investigation and resolution;

keeps all concerned parties informed.

• Closely monitors and exceeds, when possible, client claim processing turnaround times (TAT).


• Manages manual paper network process to ensure client TAT adhered to.


• Completes miscellaneous tasks as assigned by supervisor, manager, or other member of the leadership team.

Professional Experience :

• High School Diploma required. Associate’s degree in related field preferred.


• 2+ years of experience within the healthcare industry preferred.


• Experience with health / medical insurance and processing of claims.



Last updated : 2024-03-16