CLAIMS REVIEW ANALYST

State of Arkansas • Little Rock, AR

8d • $47,397 - $70,148

About The Position

The Claims Review Analyst evaluates, analyzes, and processes insurance claims to ensure compliance with agency policies, industry regulations, and legal standards. The role includes verifying claim documentation, identifying discrepancies, assessing claim validity, and recommending approval or denial based on established criteria. Analysts may specialize in health insurance, property insurance, or workers’ compensation. They contribute to minimizing risk, preventing fraud, and maintaining an efficient claims process, customer satisfaction, and operational integrity.

Requirements

• Bachelor’s degree in a relevant field such as business, finance, healthcare administration, or insurance studies.
• Proficiency in data analysis, strong attention to detail, excellent communication, and critical-thinking skills.
• Knowledge of claims management software.
• Knowledge of local, state, and federal insurance regulations.

Nice To Haves

• Proficiency in Microsoft Office applications, particularly Excel, including data entry, spreadsheet management, and reporting.
• Experience maintaining accurate records, organizing documentation, and managing multiple administrative tasks while maintaining attention to detail.
• Experience working with database systems, business management software, or electronic recordkeeping systems, including entering, updating, and verifying information.
• Experience in the insurance industry, with an emphasis on claims management processes and workflows.
• Proficiency in collaborating and managing workflows within Microsoft Teams and SharePoint.
• Exceptional organizational skills, with demonstrated experience managing digital and physical filing systems.
• Ability to oversee and optimize staff scheduling and resource allocation.

Responsibilities

• Review and analyze insurance claims for accuracy, completeness, and compliance with predetermined policy terms.
• Identify and investigate discrepancies, missing information, or potential fraud.
• Collaborate with internal personnel, including underwriting and legal teams, on complex claim assessments.
• Maintain detailed documentation of claim decisions and actions taken.
• Communicate claim outcomes and explanations to relevant organizations and individuals, such as policyholders or healthcare providers.
• Stay updated on industry regulations and trends to ensure adherence to best practices.
• Contribute to process improvement initiatives to enhance claim review efficiency.

What This Job Offers

• Job Type: Full-time