Claims Resolution Specialist
@ Claritev

Hybrid
$42,078
Hybrid
Full Time
Posted 24 days ago

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XXXXXXXXX XXXXXXXXX XXXXXX****** @claritev.com
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Job Details

About Claims Resolution Specialist

At Claritev, our dynamic team of innovative professionals is committed to bending the cost curve in healthcare. We empower our team to exceed expectations and drive transformation as a leading voice in technology, data, and healthcare innovation.

Key Responsibilities

  • Manage high volume healthcare claims to maximize savings.
  • Contact providers, negotiate claim discounts, and handle counteroffers.
  • Conduct provider research and update databases for future reference.
  • Educate providers on online portal services and maintain quality standards.
  • Collaborate across departments and adhere to HIPAA protocols.

Job Scope

This role follows established procedures to resolve routine claims, maintain high production standards, and handle high volume claim resolutions with minimal supervision.

Qualifications

  • High school diploma or GED; minimum 6 months healthcare experience, 1 year preferred.
  • State licensure or ability to obtain certification within six months.
  • Knowledge of provider billing, medical coding, and insurance procedures.
  • Excellent communication, negotiation, and organizational skills.
  • Proficient in MS Word, Excel, and database software.

Benefits and Compensation

The role offers competitive hourly wages (approximately $20.23 hourly), health benefits, 401(k) with match, bonus opportunities, paid time off, and professional development programs.

Key skills/competency

  • Claims Management
  • Negotiation
  • Provider Relations
  • Research
  • Data Analysis
  • Communication
  • Team Collaboration
  • HIPAA Compliance
  • Detail Orientation
  • Problem Solving
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How to Get Hired at Claritev

🎯 Tips for Getting Hired

  • Customize your resume: Highlight negotiation and claims experience.
  • Research Claritev: Understand their mission and innovation in healthcare.
  • Prepare for technical questions: Review claims management software knowledge.
  • Practice negotiation scenarios: Rehearse typical provider negotiation dialogues.

📝 Interview Preparation Advice

Technical Preparation

Review claims processing software basics.
Practice data entry and spreadsheet skills.
Study MS Word and Excel functionalities.
Understand HIPAA regulatory guidelines.

Behavioral Questions

Describe a challenge in negotiation.
Explain teamwork during high workloads.
Discuss handling conflicting priorities.
Share an example of problem solving.

Frequently Asked Questions