Remote Senior Claims Analyst — Detect Overpayments

MultiPlan; McLean (VA); On-site; USD 70,000 - 80,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Bonus opportunity

Job summary

Claritev, a healthcare analytics leader, seeks a Senior Claims Analyst to identify overpayments and develop new audit concepts across client programs. The role partners with cross-functional teams to research complex claims scenarios, improve processes, and drive financial results.

The incumbent will train and mentor team members, validate overpayments conceptually, and ensure HIPAA compliance. This position offers remote work within the United States and opportunities for growth and impact on

Qualifications

• Minimum high school diploma and two years' experience analyzing medical claims paid/processed data. Bachelor's degree in a relevant field strongly preferred.
• Experience on multiple claims processing platforms.
• Experience working across multiple clients with varying claims processing policies.
• Experience with inpatient, outpatient, and professional medical claims.
• Experience with DRG, Per Diem, Outpatient Surgery Groupers, RUG, OASIS, and Fee Schedule.
• Required licensures or certifications as applicable.

Responsibilities

• Researches new concepts for development to determine applicability to client requirements.
• Utilize department tools to research concepts (including CMS/OIG/RAC information, contracts, and state plans).
• Document new concepts in management-approved formats.
• Collaborate with SQL developers to output concepts per the development process.
• Communicate issues to management and assist in resolution.
• Mentor new team members and aid in conceptual validation of overpayments.
• Document concept approval forms for clients as needed.
• Collaborate across disciplines and ensure HIPAA compliance.
• Demonstrate core competencies and company values.

Skills

Data analysis

Attention to detail

Problem solving

Written communication

Time management

Self-motivation

Adaptability

Multi-client coordination

Education

High school diploma

Bachelor's degree preferred

Tools

ReThink Analyzer

Microsoft SQL

Job description

Claritev, a healthcare analytics leader, seeks a Senior Claims Analyst to identify overpayments and develop new audit concepts across client programs. The role partners with cross-functional teams to research complex claims scenarios, improve processes, and drive financial results.

The incumbent will train and mentor team members, validate overpayments conceptually, and ensure HIPAA compliance. This position offers remote work within the United States and opportunities for growth and impact on