Claims Management Analyst

 

Position Summary:

The Claims Management Analyst is responsible for overseeing the follow-up and resolution of insurance claims. This individual acts as the primary point of contact for internal teams and external partners regarding insurance claims, drives performance improvements in claim correction and resubmission, and ensures processes and systems are optimized to reduce rejection rates and support timely reimbursement. This role plays a key leadership function in identifying trends, managing high-priority accounts, and supporting the organization’s financial objectives.

Essential Job Responsibilities:

• Serve as the subject matter expert on rejections, providing support, oversight, and leadership on related processes and systems.

• Analyze trends and patterns in claim management to identify root causes and process improvement opportunities.

• Ensure claims workflows and follow-up processes are appropriately configured to correct and resubmit rejected claims in a timely and accurate manner.

• Build and maintain strong working relationships with internal departments and external vendors to enhance claims management effectiveness.

• Oversee day-to-day rejection follow-up activities to ensure timely corrections, resubmissions, and escalation of aging or high-priority rejections.

• Monitor key performance indicators and claim resolution metrics; ensure departmental goals related to claims are met.

• Lead weekly team meetings to review claims management metrics, workflow challenges, and improvement initiatives.

• Audit payer contracts, service setups, and configuration changes to ensure proper alignment with claim management procedures.

• Coordinate with leadership to communicate rejection trends, denial patterns, payer issues, and process updates.

• Develop goals and performance indicators that align claim management efforts with broader organizational strategy.

• Manage and monitor project plans related to claim resolution initiatives and ensure successful execution.

• Act as an educator to team members and stakeholders regarding best practices and improvement strategies for handling claims management.

• Identify and recommend tools or technologies to enhance claim tracking, rejection resolution, and reporting.

• Lead resolution of escalated, high-value, or problematic rejections and develop action plans to address recurring payer challenges.

• Actively participate in day-to-day claim follow-up work as needed to support team performance and ensure timely resolution of rejected claims.

• Additional responsibilities as determined by business needs.
   

Qualifications:

• Bachelor’s degree in business, Healthcare Administration, or a related field; or equivalent combination of education and experience.

• Minimum 4–6 years of experience in medical billing, insurance follow-up, or claims resolution roles.

• In-depth understanding of end-to-end insurance claims processing workflows

Required Knowledge, Skills, and Abilities:

• Willingness to actively engage in hands-on claim resolution work when necessary to meet department goals and support team workload.

• Proficiency in medical billing systems 

• Intermediate skills in Microsoft Excel (pivot tables, VLOOKUPs)

• Working knowledge of medical terminology and procedure codes.

• Excellent communication skills – both verbal and written.

• Strong organizational and time management skills; ability to manage multiple priorities.

• Analytical mindset with the ability to identify trends and propose solutions.

• Ability to solve complex problems independently and exercise critical thinking.

• Ability to maintain confidentiality of sensitive patient and business information.

• Ability to motivate and create a team environment, prioritize work distribution, exceptional organizational and time management skills.

• Requires advanced project management skills, must be able to manage multiple projects.

 

Working Conditions:

• This role requires the ability to work fully remote within standard business hours.
• Occasional extended hours may be required to meet deadlines or resolve urgent rejection-related issues.

 

Physical Requirements:

• Must be able to work at a computer for extended periods and communicate effectively via phone, email, and