CLAIMS ANALYST SKILLS, EXPERIENCE, AND JOB REQUIREMENTS
Reviewed by Lam Nguyen under Editorial Standards
Updated: Nov 19, 2024 - 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.
Professional Skills FAQs
What are professional skills?
Professional skills are abilities that help individuals perform tasks effectively in a workplace environment. These skills include both technical competencies required for specific roles and soft skills such as communication, teamwork, and problem solving.
What is the difference between hard skills and soft skills?
Hard skills are technical abilities learned through education or training, such as programming, data analysis, or laboratory testing. Soft skills refer to interpersonal abilities like communication, leadership, adaptability, and teamwork.
Why are professional skills important for careers and resumes?
Professional skills help employers evaluate whether a candidate can perform job responsibilities effectively. Listing relevant skills on a resume demonstrates qualifications and helps applications pass Applicant Tracking Systems used in modern hiring processes.
What professional skills do employers look for?
Employers usually value a combination of technical expertise and transferable workplace skills. Common examples include analytical thinking, communication, teamwork, leadership, time management, adaptability, and digital literacy.
How can professionals develop professional skills?
Professionals can develop skills through continuous learning, training programs, certifications, mentorship, and practical work experience. Staying updated with industry trends also helps individuals maintain relevant and competitive skills.
Editorial Process
Lamwork content is developed through structured review of publicly available job postings and documented hiring trends.
Editorial operations are managed by Thanh Huyen, Managing Editor, with research direction and final oversight by Lam Nguyen, Founder & Editorial Lead. Content is periodically reviewed to reflect observable labor market changes.