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 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: Client Claims Processing Policies/Systems CMS/OIG/RAC Public Information Provider/Member Contracts State Medicaid Plans Public Information Review of Adjustment Claims Document new concepts in an appropriate format outlined by management. Partner with Microsoft SQL developers to develop efficient output of concepts following the concept development process as defined by management. Communicate to management any issues that impact work performance and work with management to resolve them. 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 core competencies and values. Due to exposure of PHI sensitive data, this role is considered a High Risk Role. 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. REQUIREMENTS Minimum high school diploma and two (2) years' experience analyzing medical claims paid/processed data. Bachelor’s degree in a relevant field of study is strongly preferred. Experience on multiple claims processing platforms. Experience working across multiple clients with varying claims processing policies. Experience with various types of medical healthcare claims, including: Inpatient Outpatient Professional Experience with various types of medical healthcare payment methods, including: DRG Per Diem Outpatient Surgery Groupers RUG OASIS Fee Schedule Required licensures, professional certifications, and/or board certifications as applicable. Ability to recognize new concepts that lead to overpayments. Ability to work efficiently across multiple clients. Experience utilizing tools to identify new concepts on data (ReThink Analyzer). Strong attention to detail and proven problem-solving abilities. Excellent written communication skills. Effective time management skills. Flexibility during times of change. Highly self-motivated. Ability to quickly apply new technologies/techniques and adapt to shifting priorities and timelines. Ability to work in a standard office environment, including prolonged sitting, use of monitors, and standard office equipment. Ability to meet physical and environmental job requirements in compliance with ADA and other employment regulations. 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 otherwise required by state law 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