Claims Operations Analyst

The Claims Operations Analyst is responsible for supporting data-driven decision-making across claims operations through reporting, analysis, operational insights, and process optimization. Responsibilities can include, but are not limited to, developing and maintaining recurring and ad hoc reports, analyzing operational and claims data, supporting billing oversight activities, and assisting with operational workflows related to claims administration and vendor management.

This role is expected to leverage reporting tools, analytics, and emerging AI-enabled technologies to improve reporting accuracy, efficiency, and visibility across the organization. The Claims Operations Analyst will partner with operational leaders and cross-functional teams to provide meaningful insights, identify trends and opportunities, and support informed business decisions through accurate and impactful reporting.

Additional responsibilities may include supporting servicer maintenance and compliance tracking efforts, monitoring operational performance metrics, validating data integrity, and contributing to continuous improvement initiatives that enhance operational effectiveness and scalability.

The Claims Operations Analyst must demonstrate strong analytical, organizational, and problem-solving skills, with the ability to manage multiple priorities in a fast-paced environment while adapting to evolving business needs and operational priorities.

Education: High School Diploma or equivalent work experience

Experience: At least 2-3 years of experience in related field

• Develop, enhance, and maintain recurring, monthly, and ad hoc claims operations reporting to support business visibility and performance management.
• Analyze claims, billing, and operational data to identify trends, patterns, and actionable insights for leadership decision-making.
• Leverage AI-enabled tools and reporting capabilities to improve data accuracy, reporting efficiency, and analytical depth.
• Translate complex data sets into clear, executive-ready summaries, dashboards, and performance narratives.
• Support billing oversight activities including reconciliation, discrepancy identification, and resolution tracking.
• Assist with claims-related operational processes such as payments, reimbursements, and vendor incident reporting.
• Ensure data integrity across claims operations systems, reporting platforms, and operational datasets.
• Partner cross-functionally with leadership and operational teams to define reporting needs and performance metrics.
• Monitor operational performance indicators and proactively surface insights that support strategic and tactical decisions.
• Support servicer and vendor compliance tracking, including Certificates of Insurance and required documentation management.
• Contribute to continuous improvement initiatives by identifying opportunities to automate, streamline, or enhance reporting processes.
• Support data validation, system updates, and reporting governance standards to ensure consistency and reliability.

The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.

• Strong analytical mindset with advanced ability to interpret data and generate actionable insights.
• Proficiency in reporting tools, data visualization platforms, and advanced Excel functionality.
• Working knowledge of AI-driven analytics tools and a willingness to expand capabilities in emerging technologies.
• Strong ability to translate data into executive-level insights and business recommendations.
• High attention to detail with strong focus on data accuracy and reporting integrity.
• Ability to manage multiple priorities and deliver within tight reporting cycles.
• Strong communication skills with the ability to present findings clearly to leadership and cross-functional partners.
• Critical thinking skills with a focus on root cause analysis and performance improvement.
• Strong collaboration skills with the ability to influence and support decision-making without direct authority.
• Adaptability in a fast-evolving operational and data environment.
• Strong understanding of claims operations, billing processes, or insurance workflows preferred.
• Commitment to continuous improvement and operational excellence through data-driven decision support.