What Is a Claims Analyst?
Claims analysts examine insurance claims for medical care in order to identify whether or not costs are accurate in relation to a patients diagnosis. This usually requires them to review claim applications for completeness, verify the accuracy of application information, consult with medical specialists, and check policy files.
They have to be familiar with medical conditions and appropriate treatments, typical procedures, and average disability periods and hospital stays associated with them. After analyzing all relevant information, they then make decisions regarding the approval or denial of a claim, the authorization of appropriate payment, or the referral to an investigator for further review.
To do their job, claims analysts must have a thorough understanding of insurance policies, medical terminology, billing standards, health law, and claims adjusting. Most claims analysts in the medical field work in office environments during regular business hours. They typically work for insurance companies and the majority of their work is conducted by phone or on a computer.
How to Become a Claims Analyst
Those interested in becoming claims analysts should earn a certification, diploma, or college degree in medical insurance billing, medical claims examination, or a related subject. In these types of programs, students learn about the medical industry and insurance practices, such as coverage, policies, and claims. Common courses include insurance operations, medical terminology, medical billing and coding, interviewing techniques, medical records, health insurance law, health care financing, and claims investigation.
Depending on what state one wants to work in, specific requirements related to licensing, certifications, or education may need to be met. To succeed in this career one must have analytical and investigative and skills as well as the ability to effectively communicate and work with computers.
Most claims analysts who are just starting out obtain practical experience through in entry-level positions before advancing to supervisory or management positions.
Claims Analyst Career Outlook & Salary
As the healthcare industry grows and more medical claims are submitted to insurance companies, there will be more of a demand for qualified individuals who can verify their accuracy.
According to the Bureau of Labor Statistics, the employment of claims adjusters, appraisers, examiners, and investigators is projected to increase by 7% within the next decade, with more jobs for adjusters and claims examiners specifically occurring within the health insurance industry. This is due to the rising costs of healthcare premiums, more insurance carriers trying to minimize costs, and a higher number of claims from a growing elderly population.
While employment opportunities are expected to be good, those who want to enter this field should still expect some competition. Experienced claims analyst with a relevant educational background, solid knowledge of the insurance industry, and additional certifications will have the best job opportunities. The Bureau reported that claims adjusters, examiners, and investigators earned a median annual salary of $55,760 in May 2008.
