CLAIMS ANALYST SKILLS, EXPERIENCE, AND JOB REQUIREMENTS

The Claims Analyst specializes in independent operation with strong detail orientation and organizational skills, capable of multitasking efficiently. Brings a blend of creative and critical thinking skills, underpinned by excellent verbal and written communication capabilities. Possesses a robust working knowledge of Word, Excel, Risk Master, and Oracle, along with a solid foundation in claims examination, evaluation, and Third Party Administration concepts.

Essential Hard and Soft Skills for a Standout Claims Analyst Resume
  • Data Analysis
  • Statistical Modeling
  • Financial Reporting
  • Claims Processing
  • Risk Assessment
  • Microsoft Excel Proficiency
  • SQL Database Management
  • Software Utilization
  • Documentation Compliance
  • Policy Interpretation
  • Critical Thinking
  • Problem Solving
  • Effective Communication
  • Detail Orientation
  • Multitasking
  • Creativity
  • Initiative
  • Customer Service
  • Adaptability
  • Team Collaboration

Summary of Claims Analyst Knowledge and Qualifications on Resume

1. BA in Statistics with 3 years of Experience

  • Proficiency with Microsoft Office products including Word, Excel, Outlook, and PowerPoint
  • Ability to critically think and problem solve
  • Ability to maintain strict confidentiality
  • Ability to multi-task and adjust to changing priorities in a fast-paced environment
  • Effectively manage time, prioritize workload and meet deadlines
  • Strong teamwork skills, ability to work cooperatively and jointly with various staff members
  • Strong organizational and multi-tasking skills
  • Ability to effectively communicate, both written and verbally, with internal and external parties
  • Ability to attention to detail 
  • Ability to create value in an unstructured environment.
  • Claims handling/ reporting experience

2. BA in Business Administration with 2 years of Experience

  • Ability to operate independently
  • Detail-oriented, organized, and able to multi-task
  • Creative and critical thinking skills
  • Excellent verbal and written communication skills
  • Working knowledge of Word and Excel
  • Initiative to learn Third Party Administration concepts and philosophies.
  • Prior customer service experience within a claims environment
  • Knowledge of principles and processes for claims examination and evaluation.
  • Strong knowledge of Risk Master and Oracle.
  • Experience in exposure to Enbridge billing systems (i.e. Banner, ConTrax, etc.).
  • Demonstrated customer service skills including negotiation skills.

3. BA in Finance with 4 years of Experience

  • Prior experience in gaming/hospitality claims.
  • Prior experience in a similar resort setting.
  • Proficient knowledge, ability and skills with claims data base systems, varied computer systems and applications including but not limited to Microsoft Windows – Outlook, Word, and Excel.
  • Advanced knowledge of principles of property and casualty insurance and fundamentals of tort law.
  • Advanced knowledge of medical terminology.
  • Advanced knowledge and ability in active listening, deductive/inductive reasoning, critical thinking, diplomacy and problem-solving skills.
  • Excellent oral communication in speaking to others to convey information effectively.
  • Strong reading, written comprehension as well as writing skills.
  • High-level judgment and decision-making abilities.
  • Advanced negotiation skills to reconcile differences and bring resolve to claims in an expeditious and cost-effective manner.

4. BA in Economics with 5 years of Experience

  • Must effectively communicate, both verbally and written, with employees, supervisors and external providers
  • Strong client focus with diplomacy and clear explanation of decisions
  • Must educate and counsel on complex and sensitive issues
  • Basic mathematical skills required for calculations and ratings
  • Must be well-organized to meet heavy workload and be able to effectively manage multiple demands 
  • Must have strong teamwork skills
  • Knowledge and understanding of workers' compensation claims administration 
  • Thorough knowledge of DMS policies and procedures, knowledge of computer applications 
  • Must have thorough knowledge of Self-Insurance regulations, Case Law, Labor Code and rules and regulations of OSHA. Preferred experience with ADA and Return to Work Interactive Process.
  • Ability to work independently and as a team player.

5. BA in Risk Management with 3 years of Experience

  • Experience working in claims or healthcare environment as well as customer Service Call Center or Customer Facing positions
  • Proficient in Microsoft applications, particularly Word, Outlook and Excel
  • Ability to understand and use all systems required to perform duties, using dual screens
  • Ability to take initiative, prioritize tasks and manage workflow to meet deadlines
  • Basic understanding of medical coding guidelines and medical terminology 
  • Basic understanding of healthcare and claims concepts 
  • Experience in medical claims adjudication, healthcare billing or healthcare customer service.
  • Ability to organize, prioritize and remain flexible is essential in order to meet turnaround times and performance guarantees. 
  • Knowledge of medical, dental and pharmacy benefitsm, medical and dental terminology
  • Outstanding interpersonal skills to articulate effectively and maintain a professional relationship with a diverse workforce and executive management team.

6. BA in Actuarial Science with 2 years of Experience

  • Have strong data entry skills and the ability to following instructions to meet daily production quotas and quality requirements.
  • Strong data entry skills
  • Attention to detail and basic computer skills
  • Good organizational and time management
  • Ability to follow instructions and works well independently. 
  • High level of concentration and patience
  • Ability to work independently, prioritize, organize and assign own work to meet deadlines. 
  • Must exhibit professional behavior at all times while representing or being identified as an employee of Berkley Accident and Health. Health Care Act, etc.
  • Ability to maintain a professional appearance, adhering to Company standards.
  • Detail-oriented and reliable.

7. BA in Data Science with 4 years of Experience

  • Experience in the reinsurance industry with a good understanding of products.
  • Knowledge of regulatory/statutory guidelines including but not limited to, HIPPA, privacy, Affordable Health Care Act
  • Excellent organizational, verbal, and written communication as well as interpersonal and relationship building skills with the ability to influence and add value to the organization.
  • Ability to use mathematics to adjudicate claims.
  • Detail oriented with a high degree of accuracy and ability to multitask.
  • Ability to take direction from next level of supervision or above.
  • Ability to accept changing priorities with a minimum of disruption.
  • Strong problem solving, decision-making, reporting and analytical skills.  
  • Must possess good judgment and work effectively with internal business areas, peers and co-workers.
  • Demonstrated proficiency in Microsoft Office software, including Microsoft Word and Excel.

8. BA in Information Systems with 3 years of Experience

  • Fluent in English and Spanish.
  • Experience in preferably in the Casualty and Property Lines of Business.
  • Computer skills (Microsoft Office and Outlook).
  • Competency working with systems and software applicable to the business unit supported.
  • Strong customer services skills with a focus on the client.
  • Strong collaboration skills with an emphasis on teamwork.
  • Express genuine interest in, and providing full attention to, the content and meaning of others' messages.
  • Be able to continually improve and have an agile mindset.
  • Ability to handle multiple activities, meet deadlines and prioritize workload.
  • Strong reading comprehension, verbal and written communication skills.

9. BA in Accounting with 5 years of Experience

  • Ability to learn and maintain knowledge of Medicare fee schedules as well as Federal, State and local healthcare regulations
  • Ability to learn and maintain knowledge of medical benefits and how they are administered
  • Demonstrated experience solving complex or ambiguous problems
  • Demonstrated experience researching and understanding complex information such as government regulations, contracts, etc
  • Ability to work independently in a fast-paced environment with competing priorities
  • Demonstrated ability to communicate effectively through both written and verbal modalities
  • Proficiency with business applications like the Microsoft Office Suite
  • Demonstrated experience working with a 10-key and excellent keyboarding skills
  • Experience in Claim Processing 
  • Excellent organizational and time management skills.
Relevant Information
Claims Assessor Skills, Experience, and Job Requirements