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Claims Research Analyst Jobs (NOW HIRING)

Molina Healthcare

Analyst, Claims Research

Long Beach, CA · On-site +1

$19.84 - $38.69/hr

Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of ...

Searhc

Medical Claims Analyst

Juneau, AK

$31.83 - $44.56/hr

... research, system administration, workflow support, and data integrity monitoring to ensure ... Research, problem solving, claims analysis, and issue resolution. * Using claims processing systems ...

WebTPA

Claims Examiner I

San Antonio, TX

This will include claims research where applicable and a range of claim complexity. What Will You ... Must possess proven judgment, decision-making skills and the ability to analyze. * Ability to learn ...

Guidewell

Claims Examiner I

San Antonio, TX

This will include claims research where applicable and a range of claim complexity. What Will You ... Must possess proven judgment, decision-making skills and the ability to analyze. * Ability to learn ...

Guidewell

Claims Examiner I

San Antonio, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You ... Must possess proven judgment, decision-making skills and the ability to analyze. * Ability to learn ...

Guidewell

Claims Examiner I

Irving, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You ... Must possess proven judgment, decision-making skills and the ability to analyze. * Ability to learn ...

WebTPA

Claims Examiner I

Irving, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You ... Must possess proven judgment, decision-making skills and the ability to analyze. * Ability to learn ...

US Department of the Air Force

$49K/yr

... operations research knowledge to apply scientific methods and techniques to analyze systems ... You MUST provide transcripts to support your educational claims. Education must be accredited by an ...

US Department of the Air Force

CO

$49K/yr

... operations research knowledge to apply scientific methods and techniques to analyze systems ... You MUST provide transcripts to support your educational claims. Education must be accredited by an ...

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Claims Research Analyst information

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How much do claims research analyst jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for claims research analyst 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 does a claims research analyst do?

A Claims Research Analyst reviews, investigates, and analyzes insurance claims to determine their validity and accuracy. They gather and assess relevant documentation, such as policy information and supporting evidence, to ensure claims are processed correctly and in compliance with regulations. Analysts also communicate with claimants, providers, and other stakeholders to clarify information and resolve discrepancies. Their primary goal is to identify errors, prevent fraud, and help ensure fair claim settlements.

What is the difference between Claims Research Analyst vs Claims Adjuster?

AspectClaims Research AnalystClaims Adjuster
Primary RoleResearches and analyzes insurance claims data to identify trends and support decision-makingEvaluates and settles insurance claims by investigating damages and determining coverage
Required SkillsData analysis, research, attention to detailInvestigation, negotiation, customer service
Work EnvironmentOffice-based, research-focusedField and office-based, claims investigation
CertificationsTypically none required, but industry certifications can helpAdjuster licenses often required

While both roles work within the insurance industry, Claims Research Analysts focus on data analysis and research to support claims processes, whereas Claims Adjusters handle the investigation and settlement of individual claims. Understanding these differences helps job seekers identify the right career path based on their skills and interests.

What are the key skills and qualifications needed to thrive as a claims research analyst?

To succeed as a Claims Research Analyst, you need strong analytical abilities, attention to detail, and a background in finance, insurance, or a related field, often supported by a bachelor’s degree. Familiarity with claims management systems, data analysis tools like Excel or SQL, and knowledge of regulatory compliance are frequently required. Excellent problem-solving skills, effective communication, and the ability to manage time efficiently will set candidates apart. These competencies are crucial for accurately investigating claims, ensuring compliance, and maintaining organizational integrity.

What are some common challenges faced by claims research analysts, and how can they effectively address them?

Claims Research Analysts often encounter challenges such as interpreting complex policy language, verifying the authenticity of supporting documents, and meeting tight deadlines. To address these, it's important to develop strong analytical and organizational skills, utilize available claims management software, and maintain clear communication with both internal teams and external parties. Proactively seeking clarification from experienced colleagues and participating in ongoing training can also help analysts stay updated on industry practices and regulatory changes.
More about Claims Research Analyst jobs
What job categories do people searching Claims Research Analyst jobs look for? The top searched job categories for Claims Research Analyst jobs are:
Claims Research Analyst jobs near you
Infographic showing various Claims Research Analyst job openings in the United States as of July 2026, with employment types broken down into 89% Full Time, 6% Part Time, 1% Temporary, and 4% Contract. Highlights an 83% Physical, 7% Hybrid, and 10% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Analyst, Claims Research

Molina Healthcare

Long Beach, CA • On-site, Remote

$19.84 - $38.69/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 197 frontline employees who took The Breakroom Quiz

163rd of 301 rated insurance

Job description


JOB DESCRIPTION Job Summary
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.
Essential Job Duties
• Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.
• Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
• Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.
• Assists with reducing rework by identifying and remediating claims processing issues.
• Locates and interprets claims-related regulatory and contractual requirements.
• Tailors existing reports and/or available data to meet the needs of claims projects.
• Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.
• Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.
• Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.
• Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.
• Works collaboratively with internal/external stakeholders to define claims requirements.
• Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.
• Fields claims questions from the operations team.
• Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
• Appropriately conveys claims-related information and tailors communication based on targeted audiences.
• Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.
• Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
• Supports claims department initiatives to improve overall claims function efficiency.
Required Qualifications
• At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.
• Medical claims processing experience across multiple states, markets, and claim types.
• Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.
• Data research and analysis skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Customer service skills.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency.
Preferred Qualifications
• Health care claims analysis experience.
• Project management experience.
#PJClaims
#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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