Claims Escalation Specialist

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