Claim Escalation Specialist

Claim Escalation Specialist is responsible for managing escalated insurance claim denials and high-value outstanding accounts to ensure timely resolution and accurate reimbursement. This role involves analyzing denial trends, submitting corrected claims and appeals, and collaborating with internal teams and external stakeholders to optimize claims processing and drive successful payment outcomes.

Key Responsibilities

• Perform daily follow-ups on escalated and denied claims to ensure timely processing, reprocessing, and resolution
• Review and reconcile outstanding accounts, including identifying unposted or unidentified payments
• Prepare and submit corrected claims and appeals in compliance with payer guidelines and regulatory requirements
• Analyze denial trends and provide actionable insights to leadership to improve resolution strategies
• Coordinate with insurance companies, patients, vendors, and internal depart...