Claims Escalation Specialist

Job Summary

A company is looking for a Claims Escalation Specialist responsible for reviewing and processing healthcare claims and escalations.

Key Responsibilities

• Review and analyze healthcare claims to ensure accuracy and compliance with policies
• Manage customer-initiated claim escalations and inquiries to ensure high satisfaction
• Perform root cause analysis and collaborate with internal partners for process improvements

Required Qualifications

• High school diploma or equivalent; associate or bachelor's degree in healthcare administration preferred
• Minimum of 2 years' experience in healthcare claims examination or adjudication
• Strong knowledge of medical terminology, CPT/ICD-10 coding, and healthcare billing procedures
• Expertise in multiple claims processing platforms, including Anthem processing
• Prior experience with both manual and automated claims processing