Claims Operations Analyst

Job Description

Job Description

The Claims Operations Analyst is responsible for analyzing claims and contact center workforce data to provide meaningful operational insights and support informed business decisions across claims operations. This role evaluates claims and call volume, workload trends, staffing levels, employee productivity, and operational performance to identify anomalies, emerging trends, potential risks, and opportunities for improvement.

The analyst will develop, maintain, and interpret recurring and ad hoc reports, translating complex data into clear findings and actionable recommendations for business and operational leaders. This includes proactively identifying unusual activity, performance gaps, changes in workload or staffing needs, and other trends that may impact operational efficiency or business objectives. The role will partner with leaders to communicate findings, provide recommendations, and support decisions related to resource allocation, workforce planning, and process improvements.

• High School Diploma or equivalent work experience.
• At least 2-3 years of experience in related field.

• Developing, maintaining, and analyzing recurring and ad hoc reports, dashboards, and operational metrics to provide visibility into claims and contact center activity and business performance.
• Analyzing claims volume, workload distribution, processing times, productivity, backlogs, and service level performance to identify trends and operational opportunities.
• Supporting workforce management activities, including staffing analysis, capacity planning, workload forecasting, real time management, schedule adjustments and evaluating resource alignment against current and projected business demands.
• Identifying anomalies, unexpected fluctuations, and emerging trends within operational and workforce data, investigating potential contributing factors, and presenting findings with recommendations to business leaders.
• Monitoring key performance indicators like adherence, shrinkage, and occupancy to evaluate the impact of operational changes, staffing adjustments, and process improvements.
• Supporting billing oversight activities and operational workflows related to claims administration and vendor management.
• Supporting servicer maintenance and compliance tracking efforts, including reporting and monitoring to ensure operational accuracy and accountability.
• Validating data integrity and reporting accuracy, identifying discrepancies, and working with appropriate teams to resolve issues.
• Leveraging reporting tools, analytics, and emerging AI-enabled technologies to improve reporting efficiency, accuracy, forecasting, and operational visibility.
• Partnering with operational leaders and cross-functional teams to identify process improvements, streamline workflows, and support initiatives that enhance operational effectiveness and scalability.

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 the ability to interpret complex claims and workforce data, identify trends and anomalies, and generate actionable insights.
• Experience with contact center workforce management, including workload forecasting, scheduling, staffing analysis, capacity planning, and real-time management, with familiarity in metrics such as service level, AHT, adherence, shrinkage, and occupancy
• Proficiency in reporting tools, data visualization platforms like Power BI and Oracle, 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 meaningful business insights, recommendations, and leadership-level reporting.
• High attention to detail with a strong focus on data accuracy, reporting integrity, and identifying discrepancies.
• Ability to recognize operational trends, investigate root causes, and recommend opportunities for performance improvement.
• Ability to manage multiple priorities and deliver accurate reporting and analysis within established deadlines.
• Strong communication skills with the ability to present findings, explain trends, and communicate recommendations clearly to leadership and cross-functional partners.
• Critical thinking and problem-solving skills with a focus on connecting data trends to operational impact and business outcomes.
• 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, insurance workflows, or other high-volume contact center environments preferred.

Additional Information:

Full benefit package including medical, dental, life, vision, company paid short/long term disability, 401(k), tuition assistance and more

Job Posting Disclaimer:

Fortegra has recently been made aware of unauthorized communications regarding career opportunities by individuals not associated with Fortegra or our recruitment team. Fortegra will only contact you from the Fortegra domain address (@fortegra.com). If you receive a message from someone posing as a Fortegra recruiter via text message, WhatsApp, Telegram or other messaging platform, please report it as phishing and block the sender.

Fortegra is not accepting unsolicited resumes from search firms for this position.

Internal Notice: As part of our commitment to talent development, this position is open for internal promotion applications at the time of public posting.

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