Claims Operations Analyst: Drive Accurate Resolutions

Claritev Corporation; United States; On-site; USD 45,000 - 50,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) matching

Paid time off

Job summary

Claritev Corporation is seeking a Claims Operations Specialist in the United States to ensure accurate, timely, and compliant resolution of healthcare claims and appeals. You will support providers, clients, and members by resolving claim issues, maintaining data integrity, and ensuring proper processing.

The role emphasizes problem-solving in a fast-paced environment, collaborating with clinical, coding, and customer service teams to deliver efficient claim outcomes and exceptional service.

Qualifications

• Two years of experience in claims processing, customer service, or related operational role; or an Associate's degree.
• Experience with business systems, databases, and Microsoft Office (Word & Excel).
• Strong analytical, organizational, problem-solving, and communication skills.
• Ability to prioritize competing demands and adapt quickly in a fast-paced environment.
• Ability to work independently while handling confidential information.

Responsibilities

• Review and analyze claim appeals to ensure accurate resolutions.
• Investigate claim discrepancies and identify solutions for improved accuracy and satisfaction.
• Manage and prioritize claim inventories across inpatient, outpatient, and provider billing workflows.
• Research, retrieve, and validate information from internal and external systems for reviews and projects.
• Maintain accurate provider and claim data through data entry and validation.
• Process claim adjustments and corrected claims for proper reimbursement and adjudication.
• Coordinate workflow assignments and support continuity when distributions require manual intervention.
• Collaborate across departments to resolve issues and maintain HIPAA compliance.

Skills

Analytical skills

Communication skills

Problem-solving

Organizational skills

Independent work

Technical aptitude

Data entry

Microsoft Office

Education

High school diploma or GED

Associate's degree

Tools

Microsoft Word

Microsoft Excel

Databases

Job description

Claritev Corporation is seeking a Claims Operations Specialist in the United States to ensure accurate, timely, and compliant resolution of healthcare claims and appeals. You will support providers, clients, and members by resolving claim issues, maintaining data integrity, and ensuring proper processing.

The role emphasizes problem-solving in a fast-paced environment, collaborating with clinical, coding, and customer service teams to deliver efficient claim outcomes and exceptional service.