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Medical Claim Analyst Jobs (NOW HIRING)

EmblemHealth

Claims Triage Analyst

New York, NY · On-site

Serve as claim processing subject matter expert (SME) for resolution of issues related to claims ... Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding ...

Berkley

Claims Analyst II

Chesterfield, MO · On-site

I.) tools to enhance claim evaluation, reserve accuracy, and settlement strategies, supporting data ... I. driven tools to provide insight into complex medical issues, evaluate trends and explore ...

Sprouts Farmers Market

Claims Analyst II

Phoenix, AZ · Hybrid

Support the endtoend lifecycle of workers' compensation claims, including investigation support, compensability analysis, medical and indemnity monitoring, coordination on litigated claims, and claim ...

Centene

SIU Investigator

Sylmar, CA · On-site +1

$56K - $101K/yr

Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or ...

Forhyre

Claims Business Analyst

Charleston, WV · On-site

We are looking for a Claims Business Analyst who will be the vital link between our information ... Must understand the work flow of pharmacy claim processing or related Med D functions. For example ...

Centene

SIU Investigator

La Palma, CA · On-site +1

$56K - $101K/yr

Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or ...

Centene

SIU Investigator

Dos Palos, CA · On-site +1

$56K - $101K/yr

Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or ...

Centene

SIU Investigator

Topanga, CA · On-site +1

$56K - $101K/yr

Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or ...

Forhyre

Claims Business Analyst

Charlotte, NC · On-site

We are looking for a Claims Business Analyst who will be the vital link between our information ... Must understand the work flow of pharmacy claim processing or related Med D functions. For example ...

Centene

SIU Investigator

Palos Verdes Estates, CA · On-site +1

$56K - $101K/yr

Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or ...

Berkley

Claims Analyst II

Chesterfield, MO · On-site

I.) tools to enhance claim evaluation, reserve accuracy, and settlement strategies, supporting data ... I. driven tools to provide insight into complex medical issues, evaluate trends and explore ...

Berkley

Stop Loss Claims Analyst

Overland Park, KS · Remote

$70K - $80K/yr

As a Stop Loss Claims Analyst, you'll perform quality review and evaluation of all claim ... medical facts and specifications of the claim * Review and adjudicate claims within approved ...

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Medical Claim Analyst information

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How much do medical claim analyst jobs pay per hour?

As of Jun 12, 2026, the average hourly pay for medical claim analyst in the United States is $25.11, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $25.24 per hour, depending on experience, location, and employer.

What does a medical claim analyst do?

A medical claim analyst reviews and processes insurance claims related to healthcare services to ensure accuracy, compliance, and proper reimbursement. They analyze claim data, identify discrepancies or errors, and work with healthcare providers and insurance companies to resolve issues, often using specialized software and adhering to industry regulations.

What is the difference between Medical Claim Analyst vs Medical Billing Specialist?

AspectMedical Claim AnalystMedical Billing Specialist
CredentialsTypically requires a certification like CPC or similarOften requires certification but less specialized
Work EnvironmentInsurance companies, healthcare providers, or third-party payersMedical offices, clinics, or billing companies
Job FocusAnalyzing and processing insurance claims, ensuring accuracyPreparing and submitting patient bills, following up on payments

While both roles involve handling healthcare financial transactions, Medical Claim Analysts focus on reviewing and processing insurance claims for accuracy and reimbursement, whereas Medical Billing Specialists primarily prepare and submit patient bills and follow up on payments. Both roles require knowledge of medical coding and insurance policies but differ in their core responsibilities and work settings.

What are some common challenges Medical Claim Analysts face when reviewing complex claims?

Medical Claim Analysts often encounter challenges such as interpreting varying coding standards, handling incomplete or ambiguous documentation, and staying updated with constantly changing healthcare regulations. Managing high volumes of claims while ensuring accuracy can also be demanding, especially when claims involve specialized procedures or multi-layered insurance policies. Strong attention to detail, effective communication with providers or patients, and ongoing training help analysts overcome these obstacles and ensure timely, accurate claim processing.

How much do claims analysts make in the US?

Claims analysts in the US typically earn a median annual salary of around $45,000 to $60,000, depending on experience, location, and employer. Entry-level positions may start lower, while experienced analysts or those with specialized skills can earn higher wages, often supplemented with benefits and opportunities for advancement.

What is the role of a claims analyst?

A claims analyst reviews and processes insurance claims to ensure accuracy and compliance with policies. They analyze claim data, investigate discrepancies, and may use claims management software to facilitate the process, often working within healthcare or insurance environments. Strong attention to detail and knowledge of billing procedures are essential for this role.

How to become a medical claims analyst?

To become a medical claims analyst, typically a high school diploma or equivalent is required, with many employers preferring a bachelor's degree in health administration, finance, or a related field. Relevant skills include knowledge of insurance policies, medical billing, and claims processing software, and obtaining certifications such as the Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can enhance job prospects.

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

To thrive as a Medical Claim Analyst, you need a solid understanding of medical terminology, insurance guidelines, and claims processing, often supported by a relevant associate degree or certification. Familiarity with claims management software, ICD-10/CPT coding systems, and electronic health record (EHR) platforms is typically required. Strong attention to detail, analytical thinking, and effective communication skills help analysts resolve discrepancies and collaborate with healthcare providers. These skills ensure accurate claim evaluations, minimize errors, and contribute to efficient reimbursement processes in healthcare organizations.
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Medical Claim Analyst jobs near you
Infographic showing various Medical Claim Analyst job openings in the United States as of June 2026, with employment types broken down into 78% Full Time, 15% Part Time, and 7% Contract. Highlights an 81% Physical, 8% Hybrid, and 11% Remote job distribution, with an average salary of $52,237 per year, or $25.1 per hour.
Claims Triage Analyst

Claims Triage Analyst

EmblemHealth

New York, NY • On-site

Other

Posted 18 days ago

Job description

Summary of Position

  • Responsible for receiving, researching and resolving inquiries and requests from internal EmblemHealth departments and business partners (i.e., account management, provider network management, provider file operations, client retention, access to care, care cafe, membership, COB, Contact Center, G&A, etc.) regarding claim outcomes.
     
  • Perform root cause analysis and take appropriate steps to have corrected, working directly with support areas (EmblemHealth & CTS) as needed. 
     
  • Recommend changes in procedures, desk level procedures (DLPs) and workflow to improve quality and efficiency as needed. 
     
  • Ensure impacted claims are adjusted. 
     
  • Oversight and quality review of CTS performance.
     
  • Provide response to requestor using "speak human" terminology.


Roles and Responsibilities

  • Serve as claim processing subject matter expert (SME) for resolution of issues related to claims processing and adjudication outcomes for medical, hospital, dental claims for all EmblemHealth lines of business as requested by EmblemHealth business partners or CTS business partners. 
     
  • Research and resolve claim issues as requested and make determination of appropriateness of claim adjudication outcome and/or adjustment request. 
     
  • Provide oversight and quality review of CTS performance of the claim adjustments required.
     
  • Perform root cause analysis and take appropriate actions to ensure root cause is remediated. 
     
  • In addition to requesting configuration updates, remediation may include recommendation of changes to processing procedures, Facets workflow and desk level procedures (DLPs).
     
  • Collaborate with EmblemHealth and CTS business partners as needed to validate accuracy of benefit configuration, NetworX rate sheets, provider participation status, provider file and membership file, including COB flags impacting the claim(s) adjudication outcome. 
     
  • Manage high priority/high visibility projects to completion including manual or mass recycles and adjustments.
     
  • Ensure issue is closed, providing documentation with appropriate level of detail in "speak human", including claim adjustment detail or explanation for payment correctness to the requestor
     
  • Perform other related projects and duties as assigned

Qualifications:

  • Bachelor's degree, preferably in Business Management.
  • 3 - 5+ years of relevant, professional work experience, including 3 years of claims processing.
  • 3+ years of managerial/supervisory experience within a related health care and/or claims environment. 
  • Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits. 
  • 1 - 3+ years' experience managing in a BPASS model. 
  • Additional years of experience may be considered in lieu of educational requirements.
  • Strong knowledge of claims processing, procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications. 
  • Strong knowledge of member and provider contracts, procedures and systems.
  • Prior proven EmblemHealth experience. 
  • Strong planning, organizing and prioritizing skills; meticulous attention to detail. 
  • Strong communication skills (verbal, written, presentation, interpersonal) with all types and levels of audiences. 
  • Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.). 
  • Ability to handle multiple priorities and meet deadlines.
Additional Information
  • Requisition ID: 1000003099
  • Hiring Range: $56,160-$99,360

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