Claims Analyst

The Claims Analyst is responsible for the advanced review, analysis, and resolution of complex insurance claims, with a primary focus on denials and appeals. This role handles high-dollar and escalated claims, supports denial prevention efforts, and serves as a resource to other team members.

The position applies in-depth knowledge of payer requirements, billing guidelines, and reimbursement processes to maximize revenue recovery and improve overall claims performance.

Key responsibilities include:

• Analyze and resolve complex denied or underpaid claims across multiple payers
• Independently manage high-dollar and aged accounts requiring detailed research
• Prepare and submit first- and second-level appeals
• Compile and review supporting documentation, including medical records and coding validation
• Monitor appeal status through final resolution
• Identify root causes of denials and recurring issues
• Communicate denial trends to leadership and recommend corrective actions
• Interpret payer policies, EOBs, and reimbursement guidelines
• Participate in payer communications to resolve complex claim issues
• Maintain accurate documentation of claim activity
• Support audits and documentation reviews
• Track denial trends, appeal outcomes, and recovery efforts
• Contribute to productivity goals and recommend workflow improvements