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Claims Analyst Ii Jobs (NOW HIRING)

Network Health

Claims Analyst II

Brookfield, WI · On-site +1

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

Network Health

Claims Analyst II

Menasha, WI · On-site +1

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

Network Health, Inc

Claims Analyst II

Menasha, WI · On-site +1

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

Network Health, Inc

Claims Analyst II

Brookfield, WI · On-site +1

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

Network Health WI

Claims Analyst II

Menasha, WI · On-site

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

Towne Park

$62K - $68K/yr

The Claims Analyst II will perform a range of functions around the claims oversight and administration work in the receipt, review, and processing of claims received by Towne. This position will ...

New

NorthBay Health

Claims Analyst II (On-Site)

Fairfield, CA · On-site

$33.29 - $40.44/hr

At NorthBay Health, the Claims Analyst II is responsible for independently completing all tasks in claims adjudication, including processing adjustments. The position is co-responsible for the ...

Integrated Resources INC

Claims Analyst

Syracuse, NY · On-site

Required Experience: 0-2 years of claims processing with advancement to auditing / claims analysis / claims research. * Some project management skills. Good oral and written communication skills.

Lumen Solutions Group Inc.

Claims Analyst

Baltimore, MD · On-site

We are seeking a Claims Analyst with 2+ years of experience in claims processing, operations support, or healthcare administration. The ideal candidate will have strong experience in claims research ...

New

SkySource Solutions

Claims Analyst

Cleveland, OH · On-site

$28 - $44/hr

OH & AZ licenses ( preferred ). * 2-5+ years of claims handling experience (property, casualty, auto, liability, or specialized lines). * Strong investigative, analytical, and critical-thinking ...

PSG Global Solutions

Claims Analyst

Newark, DE · On-site

Claims Analyst (Level II) Resolves customer merchant, credit, or ATM claims within the bank's policies and procedures. Responsibilities include: investigate and decision daily incoming claims using ...

Empyreal Logistics

Claims Analyst

Englewood, CO · On-site

$75K/yr

The Claims Analyst will report to the Director of Vault Services Position Summary: The Claims ... preferred). * 2-5 years of experience in ATM operations, cash logistics, banking, armored ...

New

HomeServe

Claims Analyst

Chattanooga, TN · On-site

The Claims Analyst will utilize claims data and reporting to identify opportunities to improve ... At least 2 years of experience in data analysis, reporting, auditing, or related field and ...

HomeServe USA

Claims Analyst

Chattanooga, TN · Remote

The Claims Analyst will utilize claims data and reporting to identify opportunities to improve ... At least 2 years of experience in data analysis, reporting, auditing, or related field and ...

United Road

Claims Analyst

Romulus, MI · On-site

The Claims Analyst aids the Cargo Claims Manager in achieving the department's goals and ... Two years of claims handling experience in transportation industry preferred * Two year college ...

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Claims Analyst Ii information

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How much do claims analyst ii jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for claims analyst ii in the United States is $27.39, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $31.49 per hour, depending on experience, location, and employer.

What is the difference between Claims Analyst II vs Claims Processor?

CriteriaClaims Analyst IIClaims Processor
Required CredentialsBachelor's degree often preferred; certifications like CPC or similar beneficialHigh school diploma or equivalent; on-the-job training common
Work EnvironmentOffice setting, analytical tasks, data reviewOffice or claims department, processing claims and data entry
Employer & Industry UsageInsurance companies, healthcare providers, third-party administratorsInsurance companies, healthcare organizations, government agencies

Claims Analyst II and Claims Processor roles often overlap in insurance and healthcare industries. While Claims Analyst II typically involves more analytical and review responsibilities requiring some credentials, Claims Processors focus on data entry and claim processing. Both roles are essential in claims management but differ in complexity and required skills.

What does a Claims Analyst II do?

A Claims Analyst II is responsible for reviewing, analyzing, and processing insurance claims to ensure they are valid and comply with policy guidelines. They investigate claims, verify documentation, communicate with policyholders and providers, and determine the appropriate payout or denial of claims. This role typically requires understanding complex policies, using specialized software, and adhering to regulatory standards. Additionally, a Claims Analyst II may handle escalated or more complex claims compared to entry-level analysts and may help train or mentor junior staff.

What are the key skills and qualifications needed to thrive as a Claims Analyst II?

To thrive as a Claims Analyst II, you need strong analytical skills, attention to detail, and a solid understanding of insurance policies, often supported by a bachelor's degree in business, finance, or a related field. Familiarity with claims management software, Microsoft Excel, and industry-specific platforms like Guidewire is typically expected. Excellent communication, problem-solving abilities, and organizational skills help build rapport with clients and efficiently resolve claims. These competencies ensure accurate claim processing, minimize errors, and support customer satisfaction in a regulated industry.

Is claims processing a stressful job?

Claims processing can be a stressful job due to tight deadlines, high workload, and the need for accuracy in evaluating claims. Claims analysts often work with complex information and customer interactions, which can contribute to job stress, but workload and environment vary by employer and individual experience.

What are some common challenges faced by a Claims Analyst II, and how are they typically addressed?

A Claims Analyst II often encounters challenges such as interpreting complex policy language, managing large volumes of claims, and balancing accuracy with efficiency. These professionals must stay updated on changing regulations and company policies, and sometimes handle escalated or disputed claims. To address these challenges, Claims Analysts rely on strong analytical skills, effective communication with policyholders and teammates, and ongoing training provided by their employer. Collaboration with other departments, such as legal or underwriting, is also common to ensure thorough and fair claim resolutions.
More about Claims Analyst Ii jobs
What states have the most Claims Analyst Ii jobs? States with the most job openings for Claims Analyst Ii jobs include:
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Claims Analyst Ii jobs near you
Infographic showing various Claims Analyst Ii job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 86% Full Time, 6% Part Time, and 7% Contract. Highlights an 81% Physical, 9% Hybrid, and 10% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Claims Analyst II

Network Health

Brookfield, WI • On-site, Remote

Full-time

Posted 6 days ago

Job description

Network Health’s success is rooted in its mission to create healthy and strong Wisconsin communities. This mission drives the decisions we make, including the people we choose to join our growing team.

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following:

  • Adjudicate claims by following departmental policies, operating memos, and corporate guidelines.
  • Resolve claims and related issues in compliance with policy provisions.
  • Compare claims applications and provider statements with policy files and other records to ensure completeness and validity.
  • Process payments for claims that are approved.

This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.
Hours: 1.0 FTE, 40 hours per week between 8am-5pm Monday through Friday.

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

    • Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality.
    • Reviews claims to ensure compliance with proper billing standards and completeness of information. 
    • Obtains additional information from appropriate person and/or agency as needed.  
    • Maintains department quality standards.
    • Maintains established department turn-around processing time. Maintain and/or improves individual production rate standards and department quality standards.
    • Identifies potential coordination of benefits (COB), Workers Compensation, and Subrogation issues and adjudicates claims accordingly.
    • Investigates and resolves pending claims in accordance with established time frames.  Identifies claims needing to be pended or suspended. Reviews pending claims timely and denies claims after established time frame is reached without resolution.
    • Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed.
    • Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc.
    • Reviews home office claims for payment up to $18,000.00.
    • Reviews claims for re-pricing.  Enters eligible claim data into appropriate WRAP network re-pricing website.  Overrides claims allowed amounts to apply internal/external discounts.
    • Appropriately documents attributes and memos for pertinent information related to claims payment.
    • Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract.
    • Performs other duties and responsibilities as assigned. 

    Job Requirements:

    • High school diploma or equivalent preferred. 
    • 2-4 years claims processing experience required
    • Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation.
    • Past experience using QNXT™ Claims Workflow a plus
    • Prior experience with ACA, Medicaid, or similar health plans preferred.
    • Coding experience preferred.

     

    Network Health is an Equal Opportunity Employer.

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