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Claims Analyst
Career Insights for Compensation / Benefits Analyst
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What they do
A Compensation or Benefits Analyst evaluates and works to maintain the pay structure and benefits program at an organization. Analyzes wage and salary data and trends, monitors market conditions; works with benefits vendors, processes benefit claims for employees; monitors government employment regulations. May focus specifically on job classifications and compensation or on benefits programs such as pensions.
$88,706 / year median in the U.S.
+8% projected growth
Job Description
- Review, analyze, and adjudicate professional and facility claims in accordance with benefit plans, medical policies, and established procedures.
- Determine whether claims should be approved, denied, returned, suspended, or pended based on policy guidelines and supporting documentation.
- Verify claim accuracy, completeness, and compliance with billing standards.
- Research and gather additional information from providers, members, or other sources when necessary to support claim processing.
- Process approved claims for payment while maintaining confidentiality and data integrity.
- Investigate and resolve pending claims within established service level timeframes.
- Identify and appropriately handle Coordination of Benefits (COB), Workers' Compensation, and Subrogation-related claims.
- Monitor claims processing systems for errors and make necessary corrections or adjustments.
- Apply contract terms, provider discounts, reimbursement methodologies, and benefit interpretations accurately during claim adjudication.
- Review and process claims requiring specialized pricing, including transplant, network repricing, and COB claims.
- Enter claim data into appropriate repricing systems and apply internal or external discount arrangements as needed.
- Maintain thorough and accurate documentation related to claim decisions and payment activities.
- Meet established productivity, turnaround time, and quality standards.
- Stay current on policy updates, benefit changes, provider agreements, and reimbursement guidelines.
- Perform additional duties and special projects as assigned. Qualifications
- Strong analytical skills and attention to detail.
- Ability to interpret policies, procedures, contracts, and benefit plans.
- Experience processing or adjudicating healthcare claims preferred.
- Strong problem-solving and research abilities.
- Proficiency with claims processing systems and computer applications.
- Ability to manage confidential information with professionalism and discretion.
- Excellent organizational skills with the ability to meet productivity and quality goals in a fast-paced environment. This position is ideal for individuals who enjoy investigating complex issues, maintaining high levels of accuracy, and contributing to a positive member and provider experience.
- Job Type & Location
- This is a Contract to Hire position based out of Menasha, WI.
- Pay and Benefits
- The pay range for this position is $19.
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
- Workplace Type
- This is a fully remote position.
- Application Deadline
- This position is anticipated to close on Aug 31, 2026.
San Francisco Fair Chance Ordinance:
- Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector:
- It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
- Use of Artificial Intelligence (AI):
- We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates.