Claims Escalation Specialist

Lake Charles Memorial Health System; Lake Charles (LA); On-site; USD 42,000 - 66,000; Full time

Job summary

Lake Charles Memorial Health System in Lake Charles, LA is seeking a Claims Escalation Analyst to manage and investigate escalated claims and ensure timely resolution. The role requires sharp analytical and problem-solving abilities and excellent communication with payers, patients, and internal teams.

You will review policy language, calculate payments, post transactions, and collaborate with other departments to clear issues.

Qualifications

• 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)
• Strong organizational and communication skills, including ability to discuss medical issues.
• Negotiation skills including assertiveness and being proactive.

Responsibilities

• 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 elevate 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.

Skills

Analytical skills

Problem solving

Excellent communication

Teamwork

Typing speed 40 wpm

Education

High school diploma or GED

Job description

Lake Charles Memorial Health System in Lake Charles, LA is seeking a Claims Escalation Analyst to manage and investigate escalated claims and ensure timely resolution. The role requires sharp analytical and problem-solving abilities and excellent communication with payers, patients, and internal teams.

You will review policy language, calculate payments, post transactions, and collaborate with other departments to clear issues.