Medical Claims Analyst – Job Description

A Medical Claims Analyst is responsible for reviewing, analyzing, and processing healthcare claims to ensure they are accurate, complete, and compliant with insurance policies, healthcare regulations, and company guidelines.

Key Responsibilities:

• Review and validate medical claims for accuracy and completeness
• Analyze claim information, medical records, and supporting documentation
• Verify patient eligibility, benefits, and insurance coverage
• Interpret Explanation of Benefits (EOB) and insurance guidelines
• Investigate and resolve claim denials, rejections, and payment discrepancies
• Communicate with healthcare providers, insurance companies, and internal teams regarding claim issues
• Ensure claims are processed within established turnaround times
• Maintain accurate records and documentation of claim activities
• Adhere to HIPAA regulations and company policies

Qualifications:

• High School Graduate, College Undergraduate, or College Graduate
• Experience in US Healthcare, Medical Billing, Claims Processing, or Revenue Cycle Management is preferred
• Knowledge of healthcare and insurance terminology, including copay, coinsurance, deductibles, and EOBs
• Familiarity with CMS-1500 and UB-04 claim forms is an advantage
• Strong analytical and problem-solving skills
• Good communication and computer skills
• Ability to work in a fast-paced environment and meet deadlines

Primary Goal:

To ensure medical claims are accurately reviewed and processed, helping healthcare providers receive appropriate reimbursement while maintaining compliance with insurance and healthcare regulations.