Senior Claims Analyst

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

This role recognizes and reports new concepts for development with minimum assistance. The incumbent might be tasked to multiple clients and/or programs. They also understand the data mining process and will occasionally be tasked with training and assistance on process improvements.

Duties

1. Researches new concepts for development to determine applicability to client requirements.
2. Effectively utilize department tools to research concepts as appropriate, including but not limited to:
   • Client Claims Processing Policies/Systems
   • CMS/OIG/RAC Public Information
   • Provider/Member Contracts
   • State Medicaid Plans Public Information
   • Review of Adjustment Claims
3. Document new concepts in an appropriate format outlined by management.
4. Partner with Microsoft SQL developers to develop efficient output of concepts following the concept development process as defined by management.
5. Communicate to management any issues that impact work performance and work with management to resolve them.
6. Provide appropriate feedback to management on areas of improvement.
7. Aid in the training and mentorship of new team members as appropriate.
8. Document how to validate overpayments at a conceptual level.
9. Aid in the documentation of concept approval forms for clients as necessary.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate company core competencies and values.
13. Due to exposure of PHI sensitive data, this role is considered a High Risk Role.
14. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

COMPENSATION

The salary range for this position is $70,000 - $80,000. 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.