Claims Resolution Specialist

Claims Resolution Specialist

Join our team at Claritev as a Claims Resolution Specialist. In this role, you'll be responsible for negotiating healthcare claims to achieve maximum savings for our clients. You'll connect with healthcare providers and work towards effective resolutions.

About the Role

This position involves contacting healthcare providers to discuss negotiations for eligible claims before payment. Your goal will be to secure discounts and savings on behalf of our payors and clients.

What You'll Do

• Manage a high volume of healthcare claims to maximize savings opportunities.
• Conduct provider research to support desired savings.
• Address counteroffers and present proposals for resolution while following client guidelines.
• Seek savings opportunities with challenging providers and establish ongoing agreements.
• Update provider database for reference and claims processing.
• Initiate provider calls to negotiate claims and educate providers on our online portal.
• Meet departmental performance metrics and handle post-claim service inquiries.
• Collaborate and communicate across departments while ensuring compliance with HIPAA.
• Adhere to company policies and procedures.

What We're Looking For

• Minimum high school diploma or GED.
• At least 6 months of experience in the healthcare industry; 1 year preferred.
• State licensure certification may be required (e.g., NY Health or P&C State Adjustor license).
• Knowledge of applicable laws and statutes for Workers' Compensation or automobile medical bills is a plus.
• Familiarity with general office operations and medical insurance claim forms.
• Strong communication, teamwork, negotiation, and organizational skills.
• Ability to provide excellent customer service and pay attention to detail.
• Proficient in using software related to job responsibilities, including MS Word and Excel.
• Ability to work in a standard office environment, sitting and viewing monitors for extended periods.

What We Offer

The salary for this position is $20.23 per hour. We also offer health insurance, a 401(k) plan, and a bonus opportunity. Our benefits package includes:

• Medical, dental, and vision coverage with low deductible & copay.
• Life insurance.
• Short and long-term disability.
• 401(k) with match.
• Generous Paid Time Off.
• Paid company holidays.
• Paid Parental Leave.
• Tuition reimbursement.
• Flexible Spending Account.
• Employee Assistance Program.
• Summer Hours.

EEO Statement

Claritev is an Equal Opportunity Employer. We comply with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability, or protected veteran status. For more information on your EEO rights under the law, please click here.