Claims Escalation Analyst

• The Claims Escalation Analyst will be responsible for managing and investigating escalated claims and ensuring timely resolution. The successful candidate must have strong analytical and problem-solving skills, as well as excellent communication skills.

• →Analyze and interpret policy language, contracts and statutes
• →Maintain accurate records of all claims and ensuring timely resolution
• →Understands assigned payer’s allowable calculations in order to preview an account to determine if properly paid and identify when errors are made in payments.
• →Accurately posts transactions based on assigned duties ensuring that keying is correct for all payments, adjustments, deductibles & coinsurance assignments.
• →Able to evaluate transactions posted on an account to ensure all payments and adjustments are posted and are appropriate.
• →Works with other departments to resolve any outstanding issues delaying claims processing.
• →Communicates effectively with assigned payer and makes appropriate decisions to escalate and push claims with carriers, companies and other departments.
• →Accurately evaluates each account in order to determine what is needed, what is left outstanding and what steps are necessary to resolve the account quickly.
• →Properly utilizes productivity tracking mechanisms.
• →Works at or above the weekly set productivity standard and completes tasks in a timely manner.
• →Appropriately prioritizes work queue in order to work highest priority first based on assigned subjects.
• →Documents all information in the System following the Clear Concise Consistent method.
• →Consistently monitors assignment to ensure that all steps necessary to assist the Team with achieving its goals have been taken.
• →Able to write clearly and informatively.

• High school graduate or GED certificate, required.
• Minimum of 1-year experience in Healthcare, preferably in the insurance industry
• Proficient in Microsoft Office suite
• Analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work well in a team environment
• Adequate keyboarding skills (40 words per minute typing rate); Basic computer skills.
• Strong organizational and communication skills, including ability to discuss medical issues.
• Negotiation skills including assertiveness and being proactive.

• Work requires light duty lifting.
• Must be able to remain in a stationary position 50% of the time.
• Constantly operates a computer and other office machinery such as calculator, copy machine, and computer printer.
• Must be able to exchange accurate information with patient, family, peers and medical personnel.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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