Business Insights Analyst conducting analyses and deriving insights for business growth at TD. Collaborating with various functional areas to provide analytics and support business strategy.
About the role
- Senior Reporting Claims Analyst handling U.S. health insurance claims with focus on analysis and resolution. Collaborating with teams to ensure accurate claims processing and data-driven decision-making.
Responsibilities
- Ensure accurate and timely resolution of insurance claims through careful review, investigation, and collaboration.
- Review adjudicated claims for accuracy and compliance.
- Evaluate claims processing policies, guidelines, and provider contracts.
- Analyze historical overpayment trends and claims data to identify patterns or outliers.
- Assess insurance claims to determine coverage, liability, and eligibility.
- Confirm key claim details such as claim ID, date of service, refund amounts, and overpayment reasons.
- Validate claim information in internal systems and match details against provided documentation.
- Conduct thorough investigations, gathering all relevant documentation needed for resolution.
- Work closely with internal teams and insurance adjusters to gather information and resolve issues.
- Support team members as needed to ensure smooth project execution.
- Calculate correct claim payments.
- Maintain clear, organized records of claims, findings, and communications.
- Track overpayment projects and ensure high-quality, timely updates.
- Follow all client and company policies without exception.
Requirements
- Good basic mathematics, reasoning, and interpretation skills
- Working knowledge of MS Excel for project delivery
- Expertise in U.S. Health Insurance Claims Processing
- Excellent communication skills for client interaction
- Bachelor’s degree or equivalent work experience
- 2–3 plus years experience in claims analysis or a related field
- U.S. healthcare experience
- Strong analytical and problem‑solving skills
- Experience in reporting and data analysis
- Proficiency with claims management software and tools
- Knowledge of insurance regulations and industry best practices
- Ability to work independently and collaboratively
- High attention to detail and accuracy
- Strong organizational and time management skills
- Commitment to confidentiality and ethical standards
Benefits
- Health insurance
- Paid time off
- Professional development
- Flexible work arrangements
- Bonuses
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