Operations Analyst, I

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

Job Description

• As a Claims Operations Specialist, you will play a critical role in ensuring accurate, timely, and compliant resolution of healthcare claims and appeals. Your work directly supports providers, clients, and members by helping resolve claim-related issues, maintaining data integrity, and ensuring claims are processed correctly.
• This role is ideal for someone who enjoys problem-solving, investigating details, and working in a fast-paced environment where accuracy matters.
• You’ll collaborate with clinical teams, coding professionals, customer service partners, and other internal stakeholders to deliver efficient claim outcomes that contribute to operational excellence and an exceptional customer experience.

Why This Role Matters

• As a Claims Operations Specialist, you will play a critical role in ensuring accurate, timely, and compliant resolution of healthcare claims and appeals. Your work directly supports providers, clients, and members by helping resolve claim-related issues, maintaining data integrity, and ensuring claims are processed correctly.
• This role is ideal for someone who enjoys problem-solving, investigating details, and working in a fast-paced environment where accuracy matters.
• You’ll collaborate with clinical teams, coding professionals, customer service partners, and other internal stakeholders to deliver efficient claim outcomes that contribute to operational excellence and an exceptional customer experience.

What You’ll Do

• 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.

What You Will Bring

• High school diploma or GED and two (2) 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 elevate issues appropriately.

Preferred Qualifications

• Experience in healthcare operations, claims administration, or medical records.
• Knowledge of medical terminology, healthcare claims processing, and medical coding concepts.
• Experience supporting claim appeals, provider billing, or reimbursement-related activities.
• Familiarity with healthcare compliance requirements, including HIPAA.

Compensation

The salary range for this position is $45k-$50k. Actual compensation is based on experience, skills, education, work location, and internal equity. This position may also be eligible for incentive compensation and the comprehensive benefits outlined in the My Total Value section.

About Us

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.

Why Claritev?

Healthcare is complex. We help make it clearer.

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.

My Total Value

Claritev’s Global Total Rewards Philosophy — My Total Value — Is Grounded In Investing In Our Associates And Rewarding Performance. This Includes

• Competitive compensation and incentive opportunities (where eligible)
• Medical, dental, and vision coverage
• Life and disability coverage
• 401(k) with company match
• Employee stock purchase plan
• Flexible spending accounts and health savings accounts
• Paid time off and company holidays
• Paid parental leave
• Mental health resources
• Tuition reimbursement
• Financial planning resources
• 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.

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