Claims Escalation Analyst

Lake Charles Memorial Hospital; Lake Charles (LA); On-site; USD 42,000 - 62,000; Full time

Job summary

Lake Charles Memorial Hospital is seeking a Claims Escalation Analyst to manage and investigate escalated claims, ensuring timely resolution. The ideal candidate will have strong analytical and problem-solving skills, plus excellent communication with payers and internal teams.

Responsibilities include analyzing policy language and contracts, posting transactions, and coordinating with other departments to resolve issues delaying claims processing.

Qualifications

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Proficient in Microsoft Office suite.
• Experience in healthcare billing or insurance preferred.
• Ability to work well in a team and handle escalated claims.

Responsibilities

• Analyze and interpret policy language, contracts and statutes.
• Maintain accurate records of all claims and ensuring timely resolution.
• Preview accounts to determine proper payment and identify errors in payments.
• Post transactions accurately including payments, adjustments, deductibles & coinsurance.
• Evaluate accounts to ensure payments and adjustments are correct.
• Collaborate with other departments to resolve issues delaying claims processing.
• Communicate with the assigned payer and escalate claims with carriers and departments.
• Document information in the system following the Clear Concise Consistent method.
• Monitor assignments to ensure goals are met and tasks are timely.

Skills

Analytical skills

Problem-solving

Communication skills

Microsoft Office

Education

High school diploma or GED

Tools

Microsoft Office Suite

Job description

• 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.

SUPERVISION: Reports directly to the Collection Supervisor

RESPONSIBILITIES AND DUTIES

• 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 escalating 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.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• 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.

Physical Demands/Work Environment

• 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.

“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well‑being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.