Senior Claims Payable Analyst

Job Type:

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Sr. Claims Payable Analyst

The Sr. Claims Payable Analyst is a pivotal member of the finance department, responsible for ensuring the accuracy, compliance, and efficiency of claims payment processing. This role combines advanced analytical skills, deep knowledge of claims adjudication and payment regulations, and a commitment to operational excellence. The Sr. Claims Payment Analyst serves as a subject matter expert, resolving complex payment discrepancies, mentoring junior analysts, and driving process improvements.

Position Summary:

The Sr. Claims Payment Analyst is accountable for auditing, analyzing, and reconciling claims payments to guarantee that providers, policyholders, and vendors are reimbursed according to contractual agreements, regulatory requirements, and company policies. They play a critical role in identifying trends, root causes of payment errors, and opportunities for cost savings or process enhancements. This position requires regular collaboration with cross-functional teams, including Claims Operations, Finance, Vendor Management, Compliance, and IT.

Key Responsibilities:

• Customer Requests: Review and respond to claims processor inquires, supplier remittance requests, and other Finance inquires

• Claims Payment Analysis: Review, audit, and analyze high-volume claims payments for accuracy, timeliness, and adherence to internal and external guidelines. Investigate discrepancies and resolve complex or escalated payment issues.

• Data Research: Review claims payment data for 1099 and unclaimed property filings

• Compliance & Regulatory Adherence: Monitor compliance with state and federal regulations (1099s, Unclaimed property), and company policies regarding claims payment processing.

• Process Improvement: Identify, recommend, and implement process enhancements to increase claims payment accuracy and efficiency. Participate in system upgrades and user acceptance testing for payment processing modules.

• Reporting & Analytics: Develop and distribute regular and ad hoc reports on claims payment trends, exceptions, and key performance indicators (KPIs) for senior management and other stakeholders.

• Issue Resolution: Work with internal and external partners to resolve complex payment issues, including provider disputes, overpayments, underpayments, and adjustment requests.

• Training & Support: Provide guidance, mentoring, and training to junior analysts and claims processors. Serve as a resource for technical and procedural questions related to claims payments.

• Audit Support: Support internal and external audits by preparing thorough documentation, responding to audit requests, and implementing corrective actions as needed.

• Stakeholder Collaboration: Liaise with Vendor Management, Finance, Compliance, and other departments to streamline workflows, resolve issues, and ensure timely and accurate supplier reimbursement.

• Continuous Learning: Maintain up-to-date knowledge of industry developments, technology advancements, and regulatory changes relevant to claims payments.

Required Qualifications:

• Bachelor’s degree in business, Finance, Accounting, or a related field (or equivalent combination of education and experience).

• Minimum of 4-6 years of experience in claims processing, payment analysis, or related roles within related industry.

• In-depth understanding of claims adjudication, provider contracts, reimbursement methodologies, and payment workflows.

• Advanced proficiency in claims management systems and financial reconciliation tools.

• Strong analytical and problem-solving skills with the ability to interpret large datasets and identify trends, anomalies, and root causes.

• Proficient in Microsoft Excel, Access, and data visualization tools such as Tableau or Power BI; experience with SQL is a plus.

• Excellent communication and interpersonal skills, with the ability to present complex findings to non-technical stakeholders.

• Demonstrates ability to manage multiple priorities in a fast-paced, deadline-driven environment.

• Strong attention to detail and commitment to accuracy.

Preferred Qualifications:

• Experience in property and casualty insurance, or similar industry.

• Prior experience in high volume payment environments.

• Knowledge of state and federal compliance regulations, including Unclaimed property, 1099s, and relevant state laws.

• Experience supporting audits and/or regulatory reviews