Claims Process Analyst

Claims Process Analyst

Our client is seeking a detail-oriented Claims Process Analyst to join their Claims Payments team, supporting Property & Casualty (P&C) claims operations. This role focuses on risk identification, compliance, and process integrity to ensure claims payments are accurate, timely, and aligned with operational standards.

You will play a critical role in analyzing claims that require deeper investigation, identifying root causes of payment issues, and recommending process improvements to prevent future errors.

Key Responsibilities

• Analyze large volumes of claims data (e.g., 500800+ claims at a time) to validate system accuracy and process effectiveness
• Conduct root cause analysis to identify whether issues stem from system defects, process gaps, or compliance risks
• Prioritize and manage backlog reports, focusing on high-impact claims and time-sensitive issues
• Partner with adjusters, claims operations, and underwriting teams to resolve payment exceptions and discrepancies
• Identify opportunities to streamline workflows, improve controls, and enhance overall process efficiency
• Develop and refine standard operating procedures (SOPs) where gaps or inconsistencies exist
• Complete required documentation, including forms, reports, and member/customer communications (letters)
• Respond to ad hoc analysis requests and provide clear, actionable insights
• Deliver summaries and recommendations to leadership, supporting continuous improvement initiatives

Required Qualifications

• Experience in Property & Casualty (P&C) claims or claims operations
• Background in claims payments, underwriting support, or financial operations within insurance
• Familiarity with claims systems such as Guidewire or similar platforms
• Strong analytical and problem-solving skills with high attention to detail
• Ability to assess and differentiate system, process, and compliance-related issues
• Experience working in fast-paced, unstructured environments with shifting priorities
• Strong written communication skills, including the ability to summarize findings and provide recommendations

Peyton Resource Group