Senior Claims Analyst
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
JOB SUMMARY
JOB ROLES AND RESPONSIBILITIES
- Researches new concepts for development to determine applicability to client requirements.
- Effectively utilize department tools to research concepts as appropriate, including but not limited to:
o Client Claims Processing Policies/Systems.
o CMS/OIG/RAC Public Information.
o Provider/Member Contracts.
o State Medicaid Plans Public Information.
o Review of Adjustment Claims. - Document new concepts in an appropriate format outlined by management.
- Partners with Microsoft SQL developers to develop efficient output of concept following concept development Process as Defined by Management.
- Communicate to management any issues that impact work performance and work with management to resolve any Issues that impact work performance.
- Provide appropriate feedback to management on areas of improvement.
- Aid in the training and mentorship of new team members as appropriate.
- Document how to validate overpayments at a conceptual level.
- Aid in the documentation of concept approval forms for clients as necessary.
- Collaborate, coordinate, and communicate across disciplines and departments.
- Ensure compliance with HIPAA regulations and requirements.
- Demonstrate Company's Core Competencies and values held within.
- Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
- The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
COMPENSATION
The salary range for this position is $75-85k annually. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
- Minimum high school diploma and two (2) years' experience as analyzing medical claims paid/processed data. Bachelors' degree in a relevant field of study is strongly preferred.
- Experience on Multiple Claims Processing Platforms.
- Experience on Multiple Clients with varying Claims Processing Policies.
- Experience with Various Types of Medical Health Care Claims, including but not limited to:
- Inpatient
- Outpatient
- Professional
- Experience with Various Types of Medical Health Care Payment Methods, including but not limited to:
- DRG
- Per Diem
- Outpatient Surgery Groupers
- RUG
- OASIS
- Fee Schedule
- Required licensures, professional certifications, and/or Board certifications as applicable.
- Recognize New Concepts that Lead to Overpayments.
- Works Efficiently on Multiple Clients.
- Utilizes tools to Identify New Concepts on Data (ReThink Analyzer).
- Attention to Detail.
- Proven Problem-Solving Abilities.
- Excellent Written Communication Skills.
- Effective Time Management Skills.
- Flexible During Time of Change.
- Highly Self-Motivated.
- In Addition to Claims Analyst:
- Ability to Apply New Technologies/Techniques Quickly and Efficiently.
- Efficiently Adapt to Shifting Priorities/Timelines.
- Specifications should support the essential functions identified in the job, assuring compliance with the Americans with Disabilities Act (ADA) and other such employment-related acts (i.e., ability to stand for long periods of time, ability to interact with customers or visitors, ability to lift up to 50 pounds, ability to travel).
- Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- Paid Parental Leave
- 401(k) + match
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies 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. If you would like more information on your EEO rights under the law, please click here.
APPLICATION DEADLINE
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.
#LI-KB1
Similar Jobs
What We Do
Claritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all. We work across the healthcare value chain to expose imbalanced and inefficient pricing practices. Led by deeply experienced analysts, negotiators and innovators, Claritev provides tech-enabled solutions and services fueled by proprietary data from over 40 years of experience. Today, along with machine learning and AI, we utilize a robust enterprise platform to deliver price transparency, improve payment accuracy, and drive more meaningful analytics and decision-making. Through Claritev, providers are able to make data-enabled decisions to optimize their service offerings, market position and ultimately deliver high-quality care. Payors and third-party administrators can deliver greater flexibility and value to plan sponsors. Employers can drive cost-efficient benefit design and patients can finally afford the care they need. By focusing on customized solutions that that improve transparency, affordability and quality for all key players, we’re igniting a more competitive marketplace — one that lowers overall costs while improving quality. Claritev brings the transparency our nation needs to see its way to a better healthcare system.
