Healthcare Claims Operations Specialist

MultiPlan; McLean (VA); Presencial; USD 45.000 - 50.000; Jornada completa

Descripción de la vacante

Claritev is seeking a Claims Operations Specialist to ensure accurate, timely, and compliant resolution of healthcare claims and appeals. You will analyze claim details, collaborate with coding and clinical teams, and support efficient processing to protect data integrity and service quality.

The role requires a high school diploma or GED (or an Associate’s degree) and at least two years of experience in claims processing or related operational work, plus proficiency with Word and Excel.

Formación

• High school diploma or GED and two years of experience in claims processing, customer service, medical records, collections, data entry, database management, or a related operational role; OR an Associate's degree with no prior experience required.
• Experience working with business systems, databases, and Microsoft Office applications, including Word and 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 and sensitive information.
• Demonstrated technical aptitude and ability to identify, troubleshoot, and escalation issues appropriately.

Responsabilidades

• Review and analyze claim appeals to ensure accurate resolutions while partnering with coding and clinical teams as needed.
• Investigate claim discrepancies and identify solutions that improve claim processing accuracy and customer satisfaction.
• Manage and prioritize claim inventories across inpatient, outpatient, and provider billing workflows to support service and performance goals.
• Research, retrieve, and validate information from internal and external systems to support claim reviews and special projects.
• Maintain accurate provider and claim data through detailed data entry, validation, and database updates.
• Process claim adjustments and corrected claims to ensure appropriate reimbursement and adjudication outcomes.
• Coordinate workflow assignments and support operational continuity when automated distribution processes require manual intervention.
• Collaborate across departments to resolve issues, support business initiatives, and maintain compliance with HIPAA and organizational standards.

Conocimientos

Analytical

Organizational skills

Problem-solving

Communication skills

Educación

High school diploma or GED

Associate's degree

Herramientas

Microsoft Word

Microsoft Excel

Descripción del empleo

Claritev is seeking a Claims Operations Specialist to ensure accurate, timely, and compliant resolution of healthcare claims and appeals. You will analyze claim details, collaborate with coding and clinical teams, and support efficient processing to protect data integrity and service quality.

The role requires a high school diploma or GED (or an Associate’s degree) and at least two years of experience in claims processing or related operational work, plus proficiency with Word and Excel.