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Claims Analyst Job Description (2023)

Below is a sample Claims Analyst job description to reference when building your resume. Assess the qualifications and requirements listed to get an understanding of what you need to include on your resume for what employers expect in this field.

SUMMARY:

The Claims Analyst is responsible for overseeing the processing of insurance claims. The Claims Analyst reviews and processes all claims that come in, determining what kind of coverage is available for each claim, and then provides any necessary information to the client. In addition to their role as a customer service representative, the Claims Analyst also oversees the processing of internal documents within the company.

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FUNCTIONAL DUTIES:

  • Analyze claims to determine liability, extent of coverage, and extent of injury.
  • Perform risk management activities.   
  • Evaluate the entire claim from beginning to end, from initial contact with the customer to final settlement. 
  • Provide information to customers on claim status and progress of their case.   
  • Negotiate settlements with claimants, witnesses, attorneys and others involved in claims processing.   
  • Advise management on matters relating to claim activity as well as trends and developments in the field of claims processing.
  • Utilizes statistical analysis to evaluate effectiveness of internal and external strategies.
  • Utilizes methods to improve workers’ compensation program.
  • Identifies trends in claims patterns and emerging issues through data analysis to identify opportunities for process improvement.

REQUIREMENTS:

  • Bachelor’s degree in Finance, Accounting, or Business Administration.
  • Minimum 2 years’ experience as a Claims Adjuster.
  • Strong analytical and problem solving skills.
  • Ability to work under pressure and meet tight deadlines
  • Knowledge of legal principles required; knowledge of insurance laws (such as UIM) required; understanding of medical terminology; understanding of principles applicable to settlement negotiations; effective written communication skills required.
  • Proficient in MS Office (Office, Excel, PowerPoint) and claims management systems. 

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