Claim Resolution Specialist, II

Claritev; United States; On-site; USD 28,000 - 41,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) match

PTO

Paid holidays

Parental Leave

Tuition reimbursement

Flexible Spending

Employee assistance

Summer hours

Job summary

Claritev is hiring a negotiator to contact health care providers and secure maximum discounts for payor clients. You will research claims, communicate proposals, and manage multiple provider relationships to achieve savings targets. This role emphasizes HIPAA compliance and a results-driven, fast-paced environment.

The position offers competitive compensation, health benefits, 401(k) with match, paid time off, and opportunities for professional growth within a data-driven healthcare team.

Qualifications

• Experience negotiating healthcare claims and discounts.
• Strong communication skills with providers and clients.
• Understanding of HIPAA privacy and security requirements.

Responsibilities

• Foster and maintain provider relationships to support negotiations.
• Conduct claim research to support savings.
• Generate written and verbal communications with providers during negotiations.
• Address counteroffers and propose resolutions per client guidelines.
• Seek savings with challenging providers and new opportunities.
• Collaborate with internal and external clients and teams.
• Initiate provider calls to discuss proposals and overcome objections.
• Manage high volume of healthcare claims and meet deadlines.
• Ensure HIPAA compliance throughout processes.

Skills

Negotiation

Healthcare claims

Communication

HIPAA compliance

Job description

Job Description

JOB SUMMARY: This position is responsible for contacting health care providers to negotiate certain type and dollar size health care claims/bills. Objective is to achieve maximum discounts and savings on behalf of the payor/client.

Job Description

JOB SUMMARY: This position is responsible for contacting health care providers to negotiate certain type and dollar size health care claims/bills. Objective is to achieve maximum discounts and savings on behalf of the payor/client.

Job Role And Responsibilities

• Foster and maintain provider relationship to facilitate current and future negotiations by
• Performing claim research to provide support for desired savings.
• Generating agreements by communicating with providers by written and verbal communication throughout the negotiation process; and
• Address counteroffers received and present proposal for resolution while adhering to client guidelines and department goals.
• Seek opportunities to achieve savings with previously challenging/unsuccessful providers.
• Partnering with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts as applicable.
• Initiate provider telephone calls with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.
• Up to 40% of time will be on phone with providers.
• Meet and maintain established departmental performance metrics.
• Manage high volume of healthcare claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.
• Must be versatile to handle multiple clients with different requirements with different rules.
• Knowledge of Workers' Compensation or automobile medical ("auto") claims/bills is a plus:
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA protocol.
• 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.

JOB SCOPE

The individual in this position works under general supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the negotiation of health care claims/bills and provider agreements. Work is sometimes complex and requires some independent judgment within established guidelines. More complex issues are referred to higher levels. This job has regular contact with internal and external customers.

Compensation

The salary range for this position is 19.97-30.32 per hour. 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.

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
• 401(k) + match
• Generous Paid Time Off
• Paid company holidays
• Paid Parental Leave
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Summer Hours

About Us

Why Claritev ?Healthcare is complex. We help make it clearer. At Claritev , you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise . We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev , innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.

About The Team

My Total Value

Claritev’s Global t Otal r Ewards Philosophy — My Total Value — Is Grounded In Investing In Our Associates And Rewarding Per Formance. This Includes

• Competitive compensation and incentive opportunities (where eligible)
• Medical, d ental, and v ision coverage
• Life and d isability coverage
• 401(k) with c ompany m atch
• Employee s tock p urchase p lan
• Flexible s pending a ccounts and h ealth s avings a ccounts
• Paid t ime o ff and c ompany h olidays
• Paid p arental l eave
• Mental h ealth r e sources
• Tuitio n r eimbursement
• Financial p lanning r esources
• Professional development opportunities

Our Commitment to Inclusion

At Claritev , we believe diverse perspectives strengthen our teams and lead to better outcomes. We are committed to fostering an inclusive workplace where every associate feels respected, valued, and empowered to succeed.

Clarivet 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, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.