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Senior Claims Analyst Jobs (NOW HIRING)

Awac

Sr. Claims Analyst, D&O

Farmington, UT · On-site

$110K - $125K/yr

Senior Claims Analyst - D&O Job Summary: Investigate, evaluate, and resolve claims made against the Company's insurance policies including public and private D&O, fiduciary and crime policies. Engage ...

Awac

Sr. Claims Analyst - Cyber Claims

Farmington, UT · On-site

Promptly analyze coverage, draft accurate and timely coverage positions, and manage litigation by ... Represent Company in the resolution of claims and participate in legal proceedings, including ...

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University Health

Claims Analyst

San Antonio, TX

We are looking for an experienced Claims Analyst for our Claims department with Community First ... senior claim examiners that affect claims payment. Act as consultant to claims staff in complex ...

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Senior Claims Analyst information

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How much do senior claims analyst jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for senior claims 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 the difference between Senior Claims Analyst vs Claims Adjuster?

AspectSenior Claims AnalystClaims Adjuster
Required CredentialsBachelor's degree, industry certifications (e.g., CPCU)High school diploma or equivalent, some certifications optional
Work EnvironmentOffice-based, analytical, report-focusedFieldwork, on-site inspections, claimant interactions
Employer & Industry UsageInsurance companies, large corporationsInsurance firms, independent adjusters
Common Search & ComparisonYesNo

The main difference is that Senior Claims Analysts focus on analyzing claims data, managing complex cases, and providing insights, often working in an office setting. Claims Adjusters typically handle on-site inspections and direct claimant interactions. Both roles are essential in the insurance industry but differ in responsibilities and work environment.

What does a senior claims analyst do?

A Senior Claims Analyst is responsible for reviewing, analyzing, and processing insurance claims to ensure they are accurate and comply with policy terms. They investigate complex claims, assess liability, and determine appropriate settlements or denials. Senior Claims Analysts also mentor junior staff, handle escalated or disputed cases, and collaborate with other departments to resolve issues. Their expertise helps ensure fair claim outcomes and supports the integrity of the insurance process.

How much do senior claims analysts make in the US?

Senior claims analysts in the US typically earn an average salary between $70,000 and $90,000 per year, depending on experience, location, and industry. They often require strong analytical skills and knowledge of claims processing systems. Salaries can vary based on company size and certifications held.

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

To thrive as a Senior Claims Analyst, you need expertise in claims processing, policy interpretation, and risk assessment, usually supported by a bachelor’s degree in business, finance, or a related field. Familiarity with claims management software, data analysis tools, and relevant industry certifications (such as AIC or CPCU) is often required. Exceptional analytical thinking, attention to detail, and strong communication skills help you resolve complex claims and collaborate across teams. These abilities ensure accurate claim resolution, minimize financial risk, and maintain customer trust in a highly regulated industry.

What types of collaboration can a senior claims analyst expect with other departments?

As a Senior Claims Analyst, you will regularly collaborate with teams such as underwriting, legal, and customer service to ensure accurate claim assessments and efficient resolution. This cross-functional teamwork is essential for verifying policy details, gathering additional documentation, and addressing complex or disputed claims. Building strong relationships with these departments helps streamline processes and ensures that claim decisions are thorough and compliant with company policies.
More about Senior Claims Analyst jobs
What cities are hiring for Senior Claims Analyst jobs? Cities with the most Senior Claims Analyst job openings:
What are the most commonly searched types of Claims Analyst jobs? The most popular types of Claims Analyst jobs are:
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What job categories do people searching Senior Claims Analyst jobs look for? The top searched job categories for Senior Claims Analyst jobs are:
Senior Claims Analyst jobs near you
Infographic showing various Senior Claims Analyst job openings in the United States as of August 2026, with employment types broken down into 85% Full Time, 7% Part Time, 1% Temporary, and 7% Contract. Highlights an 80% Physical, 8% Hybrid, and 12% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Senior Claims Analyst - Hospital Bill Review

SmartLight Analytics

Plano, TX • On-site, Remote

$85K - $105K/yr

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

We are seeking an experienced Senior Claims Analyst with deep expertise in hospital claims adjudication, stop loss reporting, high-cost/catastrophic claims, and DRG (Diagnosis-Related Group) reimbursement methodology. This individual will analyze itemized hospital bills and claims data to identify billing errors, coding discrepancies, DRG misassignments, and other overpayment opportunities, then work directly with claims administrators on behalf of our ASO clients to secure claim adjustments, recoveries, and repricing.
This is a highly analytical, client-facing role requiring both technical claims expertise and strong negotiation/communication skills.
Key Responsibilities
Claims Analysis & Review
  • Perform detailed audits of hospital and facility claims, including itemized bills, UB-04 claim forms, medical records, and remittance advices, to validate billing accuracy.
  • Analyze DRG assignments and coding to identify DRG upcoding, unbundling, duplicate billing, and other irregularities that affect reimbursement.
  • Review high-cost and catastrophic claims (typically $100K+) to identify overpayments, contract misapplication, and opportunities for negotiated adjustments.
  • Evaluate claims against plan documents, provider contracts, reference-based pricing methodologies, and CMS guidelines to determine appropriate reimbursement.
Stop Loss & High-Cost Claims Expertise
  • Understand and apply stop loss (specific and aggregate) provisions, laser terms, and reporting requirements as they relate to claim adjustments and client financial exposure.
  • Coordinate with stop loss carriers and reinsurers as needed to ensure adjustments and recoveries are properly reflected in stop loss reimbursement calculations.
  • Identify claims nearing or exceeding specific deductible thresholds and prioritize review accordingly.
Client Advocacy & Claims Administrator Negotiation
  • Serve as the subject matter expert and advocate on behalf of ASO clients in disputes with claims administrators (TPAs) and carriers regarding claim payment accuracy.
  • Prepare clear, well-documented findings packages (clinical, contractual, and coding rationale) to support requested claim adjustments and appeals.
  • Lead or support negotiations with claims administrators to reach adjusted payment resolutions.
  • Track disputes through resolution, escalating unresolved cases appropriately and maintaining strong working relationships with TPA claims and provider relations teams.
Data & Reporting
  • Analyze large claims data sets to identify trends, outlier claims, and systemic overpayment patterns across client populations.
  • Build and maintain claim tracking logs, savings reports, and client-facing summaries of identified and recovered savings.
  • Partner with internal data/analytics teams to refine claim-flagging logic and improve identification of high-value review opportunities.
Required Qualifications
  • 5+ years of experience in hospital claims analysis, medical bill review, claims auditing, or payment integrity, with direct exposure to self-funded/ASO plans.
  • Strong working knowledge of DRG methodology (MS-DRG/APR-DRG), UB-04 billing, ICD-10-CM/PCS, CPT/HCPCS coding, and hospital chargemaster structures.
  • Demonstrated understanding of stop loss insurance, including specific/aggregate deductibles, laser provisions, and how claim adjustments impact stop loss reimbursement.
  • Experience analyzing high-cost/catastrophic claims and identifying overpayment or billing error patterns.
  • Prior experience interacting with or negotiating against TPAs, insurance carriers, or claims administrators on disputed claims.
  • Proficiency with claims data analysis tools (Excel required; SQL, Access, or claims analytics platforms a plus)
  • Excellent written and verbal communication skills, with the ability to build persuasive, well-supported adjustment requests and appeals.
  • Strong attention to detail and ability to manage a high volume of complex claims simultaneously.
Preferred Qualifications
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Medical Bill Review Specialist, or similar credential.
  • Prior experience at a TPA, insurance carrier, hospital billing/coding department, or payment integrity/cost containment vendor.
  • Familiarity with reference-based pricing (RBP), Medicare fee schedules, and out-of-network claims repricing.
  • Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and medical necessity issues.
What Success Looks Like
  • Consistent identification of material overpayments and billing errors on high-cost hospital claims.
  • Strong track record of securing favorable claim adjustments through negotiation with claims administrators.
  • Clear, professional communication that strengthens client trust and TPA relationships.
  • Measurable contribution to client savings and stop loss cost containment.

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