CrawlJobs Logo
Robert Half Logo Robert Half · Insurance

Claims Analyst

United States, Providence · Job Posted April 12, 2026
Apply Position
Job Link Share

Job Description

We are seeking a detail-oriented Claims Analyst for a long-term contract on site in Providence, RI. Strong experience in Coordination of Benefits (COB), orthodontic or medical claims processing, and suspended/pended claims resolution. This role requires a thorough understanding of industry guidelines, plan provisions, and claim adjudication processes to ensure accurate and timely claim outcomes.

Job Responsibility

  • Coordination of Benefits (COB) Processing: Review and adjudicate claims to determine primary and secondary coverage in accordance with COB rules
  • Verify subscriber and dependent eligibility across multiple insurance plans
  • Apply industry-standard guidelines to ensure accurate benefit determination
  • Calculate correct payment amounts following primary insurer adjudication
  • Adjust claims based on Explanations of Benefits (EOBs) received from other carriers
  • Orthodontic Claims Processing: Evaluate orthodontic treatment plans for coverage eligibility and plan compliance
  • Verify lifetime maximums, age limits, and plan-specific orthodontic provisions
  • Process initial banding/bonding claims and ongoing periodic payments
  • Calculate prorated payments over the course of treatment
  • Monitor continuation of treatment and confirm ongoing patient eligibility
  • Suspended / Pended Claims Handling: Analyze suspended or pended claims to identify errors, missing documentation, or review flags
  • Determine root causes such as eligibility discrepancies, coding issues, or COB conflicts
  • Prioritize suspended claims based on aging, urgency, and service-level agreements (SLAs)
  • Escalate complex or high-risk issues to senior analysts or supervisors as appropriate
  • Ensure timely and compliant resolution in accordance with turnaround time standards

Requirements

  • Prior experience in dental and/or healthcare claims processing preferred
  • Strong knowledge of COB rules, orthodontic benefits, and claim adjudication practices
  • Ability to interpret EOBs, plan documents, and coverage guidelines
  • Excellent analytical skills with strong attention to detail
  • Ability to manage multiple priorities and meet deadlines in a fast-paced environment

What we offer

  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in company 401(k) plan
Robert Half - All Job Offers

Looking for more opportunities?

Search for other job offers that match your skills and interests.

Suggested Tags: Frontend Developer Secretary Talent Manager Salesforce Administrator Data Analyst
Similar Jobs for

Claims Analyst

8 matching positions

Insurance Claim Analyst

Working as part of an integrated strategic claims oversight team, this position ...
Location
Location
United States , Hingham
Salary
Salary:
67000.00 - 75000.00 USD / Year
anntaylor.com Logo
Ann Taylor
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Experience in the insurance industry as an adjuster or in a corporate insurance capacity a plus
  • Strong written and oral communication skills necessary
  • Proficient in Excel
  • Knowledge of Oracle and SAP a plus
  • Knowledge of insurance or workers comp terminology and concepts a plus
Job Responsibility
Job Responsibility
  • Operational effectiveness of claims process and strategy across workers comp, general liability and auto claims
  • Develop and maintain strong partnerships with peers across the organization and primary contact for internal and external contacts on all casualty claims
  • Recommend and help to maintain day-to-day claim processes that drive Insurer/TPA performance
  • Monitors compliance with company policy regarding loss-reporting and claim handling standards and works collectively with Asset Protection to identify non-compliant reporting trends and drive improved reporting across field, DC and office locations
  • Monitors all open claims for proper reserving and adjuster performance and assist the Sr. Mgr. of Claims with achieving optimal claim service deliverables and working claims toward final resolution
  • Monitors claim frequency and/or severity within locations and communicates concerns across the Insurance, Store Facilities and Asset Protection Teams
  • Assist Mgr of Occ Health with the tracking and documentation of disability periods associated with workers comp claims in the internal rmis system
  • Assist with tracking and documentation of information required for the Y/E Dept of Labor/Osha recordkeeping process
  • Track and document litigation data in rmis system
  • Provides back-up to Sr. Claim Manager on all claim related invoicing
What we offer
What we offer
  • Merchandise discount at select KnitWell Group brands
  • Support for individual development plus opportunities for career mobility within our family of brands
  • A culture of giving back – local volunteer opportunities, annual donation and volunteer match to eligible nonprofit organizations, and philanthropic activities to support our communities
  • Medical, dental, vision insurance & 401(K)
  • Employee Assistance Program (EAP)
  • Time off – paid time off & holidays
  • Fulltime
Read More
Arrow Right

Claims Operations Analyst

Great new role to join an insurance organisation, based in The City of London.
Location
Location
United Kingdom , London
Salary
Salary:
Not provided
michaeljamesassociates.com Logo
Michael James Associates
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Must have at least 4-5 years working in insurance
  • understanding of Lloyd’s claims processes and systems, including ECF
  • Fulltime
Read More
Arrow Right

Motor Pricing Analyst

DLG is evolving. Across every part of our business, teams are embracing new oppo...
Location
Location
United Kingdom , London
Salary
Salary:
Not provided
directlinegroup.co.uk Logo
Direct Line Group
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Strong knowledge of Python and SQL
  • Excellent analytical and problem‑solving skills, with the ability to communicate technical concepts clearly
  • Insurance knowledge and understanding, ideally gained within a data analysis environment
  • Transferable analytical experience from roles such as MI Analyst, Insight Analyst, Data Analyst, Claims Analyst, Risk Analyst, Fraud Analytics Analyst, Underwriting Analyst or Portfolio Analyst
  • A numerate degree such as Mathematics, Statistics, Computing, or a related subject
Job Responsibility
Job Responsibility
  • Building and maintaining pricing models in Python and SQL
  • Analysing performance data to identify trends, risks and opportunities
  • Supporting the delivery of pricing changes through Radar
  • Ensuring decisions, assumptions and outcomes are clearly documented
  • Partnering with colleagues across Trading, Risk and Underwriting to support pricing strategy
  • Developing efficient code and processes to improve the accuracy, speed and reliability of analysis
What we offer
What we offer
  • 9% employer pension contribution
  • Annual company bonus of up to 10%
  • 50% off home, motor and pet insurance, plus free Green Flag breakdown cover
  • Generous holiday allowance
  • Flexible benefits package, including optional health and dental insurance
  • EV car scheme, enabling colleagues to lease a new electric or plug‑in hybrid vehicle in a tax‑efficient way
  • Buy‑as‑you‑earn share scheme
  • Employee discounts and cashback
  • 22 days holiday rising to 30 days depending on your role. Plus the chance to buy and sell up to 5 days
  • Income protection on 50% of your salary for 5 years
  • Fulltime
Read More
Arrow Right

Claims Data Analyst

Working in our Store Operations & Support team, this role supports Profectus use...
Location
Location
Salary
Salary:
Not provided
chemistwarehouse.com.au Logo
Chemist Warehouse
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 1-2 years’ experience in a similar role, ideally within claims, data, analytics, or a business-focused environment
  • Intermediate to advanced Microsoft Excel skills, with the ability to analyse data and produce meaningful insights
  • Excellent written and verbal communication skills, with the confidence to deliver training and liaise with a wide range of stakeholders
  • Highly adaptable and comfortable working in an environment with evolving processes and priorities
  • Exceptional attention to detail, with the ability to identify, investigate, and resolve process issues
  • Proactive, results-driven, and willing to take initiative with a hands-on, practical approach
Job Responsibility
Job Responsibility
  • Assist Profectus users with creating error-free agreements, updating information in existing agreements, and managing claims
  • Support the delivery of group user training sessions and conduct one-on-one training with users as required
  • Update process flowcharts on a regular basis to ensure information remains current and accurate
  • Prepare and distribute regular reports to stakeholders, such as the Monthly Agreements Report and Monthly Claims Approval Report
  • Provide distributor breakdown reports to suppliers when requested
  • Support the Profectus audit process by validating missing claims
  • Assist the Senior Claims Management Analyst with ad-hoc stakeholder requests and help resolve day-to-day process issues
What we offer
What we offer
  • Career growth and development opportunities in a supportive and collaborative working environment
  • Access to discounts across all our affiliated brands, as well as other retail partnerships
  • Free annual flu vaccinations
  • Access to our Employee Assistance Program
  • Fulltime
Read More
Arrow Right

Claims Strategy Associate

Are you looking for a new challenge? Fancy helping us shape the future of motor ...
Location
Location
United Kingdom , London
Salary
Salary:
Not provided
prima.it Logo
Prima
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2-4 years’ experience at a top-tier Consulting firm, Investment Manager, Private Equity firm, or Investment Bank (ideally with exposure to Operations)
  • Ability to mix strong quantitative analytical skills with commercial acumen in order to drive actionable business insights
  • Strong fluency with data is essential
  • Strong interest in Motor Insurance and Technology / AI developments
  • Excellent verbal and written communication skills
  • Strong attention to detail, with a problem-solving attitude
  • Comfortable working in a growing / scale-up business environment
Job Responsibility
Job Responsibility
  • Build a rich and comprehensive suit of Claims Intelligence to support the Head of Claims
  • Translate complex statistical findings into simple, meaningful, and high-impact insights
  • Work with our UK Claims Data Analyst to build early-warning systems for Claims
  • Lead deep-dive pieces of analysis around specific topics, as well as incubating operational improvement initiatives
  • Assume line management responsibility for the UK Claims Data Analyst, providing coaching, mentoring, and a clear roadmap for professional development
What we offer
What we offer
  • Hybrid working
  • Access to learning resources, mentorship and a growth plan tailored to you
  • Private healthcare
  • Gym discounts
  • Wellbeing programs
  • Mental health support
  • Fulltime
Read More
Arrow Right

Claims Strategy Associate

Are you looking for a new challenge? Fancy helping us shape the future of motor ...
Location
Location
United Kingdom , Manchester
Salary
Salary:
Not provided
prima.it Logo
Prima
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2-4 years’ experience at a top-tier Consulting firm, Investment Manager, Private Equity firm, or Investment Bank (ideally with exposure to Operations)
  • Ability to mix strong quantitative analytical skills with commercial acumen in order to drive actionable business insights
  • Strong fluency with data is essential
  • Strong interest in Motor Insurance and Technology / AI developments
  • Excellent verbal and written communication skills
  • Strong attention to detail, with a problem-solving attitude
  • Comfortable working in a growing / scale-up business environment
Job Responsibility
Job Responsibility
  • Build a rich and comprehensive suit of Claims Intelligence to support the Head of Claims
  • Translate complex statistical findings into simple, meaningful, and high-impact insights
  • Work with our UK Claims Data Analyst to build early-warning systems for Claims
  • Lead deep-dive pieces of analysis around specific topics, as well as incubating operational improvement initiatives
  • Assume line management responsibility for the UK Claims Data Analyst, providing coaching, mentoring, and a clear roadmap for professional development
What we offer
What we offer
  • Hybrid working
  • Access to learning resources, mentorship and a growth plan tailored to you
  • Private healthcare
  • Gym discounts
  • Wellbeing programs
  • Mental health support
  • Fulltime
Read More
Arrow Right

Claims Associate

Are you looking for a new challenge? Fancy helping us shape the future of motor ...
Location
Location
United Kingdom , London
Salary
Salary:
Not provided
prima.it Logo
Prima
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2-4 years’ experience at a top-tier Consulting firm, Investment Manager, Private Equity firm, or Investment Bank (ideally with exposure to Operations)
  • Ability to mix strong quantitative analytical skills with commercial acumen in order to drive actionable business insights
  • Strong fluency with data is essential
  • Strong interest in Motor Insurance and Technology / AI developments
  • Excellent verbal and written communication skills
  • Strong attention to detail, with a problem-solving attitude
  • Comfortable working in a growing / scale-up business environment
Job Responsibility
Job Responsibility
  • Build a rich and comprehensive suit of Claims Intelligence to support the Head of Claims
  • Translate complex statistical findings into simple, meaningful, and high-impact insights
  • Work with our UK Claims Data Analyst to build early-warning systems for Claims
  • Lead deep-dive pieces of analysis around specific topics, as well as incubating operational improvement initiatives
  • Assume line management responsibility for the UK Claims Data Analyst, providing coaching, mentoring, and a clear roadmap for professional development
What we offer
What we offer
  • Hybrid working
  • Access to learning resources, mentorship and a growth plan tailored to you
  • Private healthcare
  • Gym discounts
  • Wellbeing programs
  • Mental health support
  • Fulltime
Read More
Arrow Right

Business Analyst

The Business Analyst role at NTT DATA involves working on P&C claims initiatives...
Location
Location
India , hyderabad
Salary
Salary:
Not provided
nttdata.com Logo
NTT DATA
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Strong hands-on experience in P&C Insurance, specifically Claims domain
  • Proven expertise in Guidewire ClaimCenter (configuration, workflows, FNOL, claims lifecycle)
  • Solid understanding of claims processing, adjudication, reserves, subrogation, and settlements
  • Experience gathering and documenting business requirements (BRD, FRD, user stories)
  • Ability to work closely with business stakeholders, QA, and development teams
  • Knowledge of insurance data models, policy, claims, and exposure relationships
  • Familiarity with Agile/Scrum methodologies and sprint ceremonies
  • Strong analytical and problem-solving skills with attention to detail
  • Excellent verbal and written communication skills for global stakeholders
  • Willingness and ability to work in 2 PM – 11 PM IST shift with overlapping US business hours
Job Responsibility
Job Responsibility
  • Act as a Business Analyst for P&C claims initiatives using Guidewire ClaimCenter
  • Elicit, analyze, and document end-to-end claims business requirements
  • Translate business needs into functional specifications and user stories
  • Support configuration and enhancement of ClaimCenter modules and workflows
  • Collaborate with product owners, developers, and QA during design and delivery
  • Participate in UAT planning, execution, and defect triage for claims applications
  • Ensure solutions align with insurance regulations, compliance, and best practices
  • Provide functional support during production issues and change requests
  • Facilitate workshops, walkthroughs, and stakeholder reviews across geographies
  • Continuously improve claims processes through data-driven insights and analysis
Read More
Arrow Right