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Claims System Analyst Jobs (NOW HIRING)

Claims Analyst

Fresno, CA · Remote

$21 - $29/hr

Conducts contract review and sets rates within the claim adjudication system. * Collaborates with ... Review and analyze claims loss, expense reserves and reconcile claims reports with authorizations ...

Bring data from various policy and claims system / platforms into one confined data model by ... Analytics requirements collection with business interface. * Experience in mapping multiple data ...

Hospital Claims Processor V

Manhattan, NY

$18.75 - $23.75/hr

... system (QNXT) * Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and ... Demonstrated organizational, perform multiple priorities, and analytical skills with the ability to ...

Claims Processor

Portland, OR · On-site

$24 - $26/hr

Experience with reporting and data analysis related to claims * Coding or system configuration experience * Background in multi‐employer trusts or benefits administration * Experience supporting ...

We are seeking a Healthcare System Analyst with strong experience in payer systems and healthcare ... Claims Adjudication, Billing, Appeals, and Grievances. * Experience with Facets platform, including ...

Documentation Analysis: Evaluate claim documents, medical records, and benefit summaries to ... Enter claim details accurately into the claims system and maintain complete records. * Problem ...

... claims system with all information available for all parties involved. • Generate claim data ... analyze, explore and evaluate information. • Be able to identify a problem while also having a ...

Hospital Claims Processor V

Manhattan, NY · On-site

$18.75 - $23.75/hr

... system (QNXT) Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and ... and analytical skills with the ability to follow through on assignments Able to work well ...

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Claims System Analyst information

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How much do claims system analyst jobs pay per hour?

As of Jul 5, 2026, the average hourly pay for claims system 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 is a Claims System Analyst?

A Claims System Analyst is a professional who manages and maintains the software systems used to process insurance claims. They analyze system performance, troubleshoot issues, implement updates, and ensure data accuracy within claims processing platforms. These analysts often work with IT teams and business stakeholders to optimize workflow, improve system efficiency, and support regulatory compliance. Their role is crucial in ensuring that claims are processed smoothly and accurately.

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

AspectClaims System AnalystClaims Processor
Required CredentialsBachelor's degree in IT, Business, or related field; knowledge of claims softwareHigh school diploma or equivalent; on-the-job training
Work EnvironmentOffice setting, working with IT teams and claim systemsOffice or remote, handling claim documentation and data entry
Employer & Industry UsageInsurance companies, healthcare providers, third-party administratorsInsurance companies, healthcare providers, claims departments
Common Search & ComparisonClaims System Analyst vs Claims Processor

The Claims System Analyst focuses on managing and improving claims software systems, requiring technical skills and analytical abilities. In contrast, Claims Processors handle the day-to-day processing of claims, emphasizing attention to detail and customer service. Both roles are essential in the claims industry but differ in responsibilities and skill requirements.

What are the key skills and qualifications needed to thrive as a Claims System Analyst, and why are they important?

To thrive as a Claims System Analyst, you need strong analytical skills, attention to detail, and a background in information systems or a related field, often supported by a relevant degree or industry experience. Familiarity with claims management software, SQL databases, and process automation tools is typically required, and certifications such as CPCU or AIC can be advantageous. Excellent problem-solving, communication, and teamwork abilities help analysts collaborate effectively with IT and business stakeholders. These skills ensure accurate claims processing, system optimization, and seamless integration of technology with business objectives.

What are some common challenges a Claims System Analyst faces when supporting system upgrades or implementations?

A Claims System Analyst often encounters challenges such as ensuring data integrity during migration, aligning system functionalities with constantly evolving business rules, and minimizing disruptions to ongoing claims processing. Collaborating across teams—like IT, business users, and vendors—is essential to address integration issues and user acceptance testing. Proactively communicating changes and providing thorough documentation helps ease transitions and supports end-users effectively.
More about Claims System Analyst jobs

Business Analyst I, II, III (Claims)

Windward Risk Managers

Boca Raton, FL

Full-time

Posted 9 days ago


Job description

Position Summary:

We are seeking an experienced Property & Casualty Claims Business Analyst with deep knowledge of Homeowners Insurance claim handling, ideally in Florida. This role will partner with the Claims department and development teams to document current processes, define requirements, and support the creation of a streamlined, automated work management system that enhances accuracy, compliance, and efficiency. The analyst will serve as the bridge between business stakeholders and technical teams, ensuring solutions are practical, sustainable, and aligned with business needs.

The ideal candidate is self-driven, detail-oriented, and able to work independently while engaging with stakeholders at all levels. This role requires balancing shifting priorities, managing scope changes, and driving projects to completion in a complex environment.
 

Essential Functions:

Business & Systems Analysis

  • Partner with Claims leadership and staff to understand, document, and analyze current workflows, systems, and processes.
  • Elicit, refine, and prioritize business requirements, ensuring clarity and alignment with strategic goals.
  • Translate business needs into functional and technical requirements for system design and automation.
  • Perform impact analysis to assess downstream effects on systems, operations, and compliance.

Process Optimization & Automation

  • Identify opportunities to streamline claims processes and reduce manual intervention.
  • Recommend and document process improvements aligned with regulatory compliance and industry best practices.
  • Collaborate with IT and Claims teams to design, test, and implement new or enhanced system features.

Project Delivery & Stakeholder Engagement

  • Lead requirement-gathering sessions, workshops, and user story creation with stakeholders who may have evolving needs.
  • Maintain scope discipline while fostering collaboration, ensuring changes are well-documented and approved.
  • Conduct user acceptance testing, validate solutions, and oversee smooth adoption of new workflows.
  • Provide regular project updates and maintain transparent communication across teams.

Documentation & Quality Assurance

  • Develop and maintain detailed documentation of workflows, requirements, and system configurations.
  • Establish clear testing plans and coordinate defect resolution.
  • Monitor outcomes to confirm implemented solutions meet business objectives and compliance standards.

Production Support & Issue Resolution

  • Act as the escalation point for Claims-related system issues, prioritizing incidents based on impact and severity.
  • Troubleshoot escalated help desk tickets, determine root cause, and work with IT/development teams to drive issues to prompt resolution.
  • Ensure timely communication with stakeholders on issue status and resolution progress.

Required Education and Experience:

  • Bachelor’s degree or equivalent combination of education and relevant work experience.
  • Professional experience in the Property & Casualty Homeowners and/or Residential Commercial insurance industry functioning in a Claims System Business Analyst capacity, including requirements elicitation, documentation, and collaboration with technical teams to implement changes to insurance or policy administration systems.
  • Proven experience analyzing business problems, troubleshooting issues, and applying logical, detail-oriented approaches to develop effective solutions with limited supervision.
  • Demonstrated experience managing multiple assignments simultaneously, prioritizing work, managing scope, and driving work to completion with minimal supervision in a fast-paced, results-driven environment.
  • Demonstrated experience working with cross-functional teams, business stakeholders, and technical resources, with strong written and verbal communication skills.
  • Demonstrated experience of insurance claims processes, regulatory considerations, and system workflows.

Preferred Qualifications:

  • 3+ years of professional experience in a Claims Business Analyst role within the Property & Casualty insurance industry.
  • Experience supporting Homeowners and/or Residential Commercial lines of business for Florida and/or California risks, including familiarity with state-specific claims processes and regulatory requirements.
  • Experience with Duck Creek, SugarCRM, ClickClaims, or similar claims workflow platforms.
  • Familiarity with regulated environments such as Florida or California.
  • Proficiency with tools such as SQL, Excel, Visio, Jira, or similar.
  • Experience with process modeling, system integrations, and data analysis.
  • Business Analyst certification (CBAP, CCBA) a plus.

Essential Skills:

  • Ability to understand technical concepts and communicate effectively with developers and system vendors.
  • Strong analytical and critical-thinking skills, with the ability to evaluate business needs and translate them into clear, well-defined requirements.
  • Ability to work independently with minimal supervision while maintaining accountability for quality and timeliness of deliverables.
  • Strong problem-solving skills, including the ability to research issues, identify root causes, and recommend practical solutions.
  • Ability to understand complex business processes, system and process workflows, and dependencies.
  • Proficiency with business analysis, documentation, and collaboration tools used to support project delivery.
  • Ability to communicate confidently and effectively with executive leadership; demonstrating professionalism, clarity, and resilience.
  • Strong interpersonal skills with the ability to navigate complex stakeholder dynamics and ensure alignment across departments.

Due to current business and operational considerations, we currently hire employees residing in the following states at this time: AL, AR, CA, CT, FL, GA, KY, MO, NC, NV, OH, SC, TN, TX, VA, and WI.

Work Authorization Requirement:

  • This role requires permanent U.S. work authorization and does not offer employer sponsorship now or in the future.

WRM is committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, or veteran status. We take affirmative action to ensure that all employment decisions are based on merit, qualifications, and abilities.
Notice to Third Party Agencies: WRM does not accept unsolicited resumes from third party recruiting firms. Absent a signed Service Agreement by WRM’s Human Resources Department, WRM reserves the right to pursue and hire these candidates without financial obligation to recruiters or agencies.