Claim Resolution Specialist, II

About the Role

This position is responsible for contacting healthcare providers to negotiate specific types and dollar amounts of healthcare claims/bills. The objective is to achieve maximum discounts and savings on behalf of the payor/client.

Due to exposure of PHI-sensitive data, this role is considered a High Risk Role. The position responsibilities outlined are not all-encompassing; other duties, responsibilities, and qualifications may be required as necessary.

Responsibilities

• Foster and maintain provider relationships to facilitate current and future negotiations.
• Perform claim research to support desired savings.
• Generate agreements through written and verbal communication with providers throughout the negotiation process.
• Address counteroffers and present proposals for resolution while adhering to client guidelines and department goals.
• Seek opportunities to achieve savings with previously challenging or unsuccessful providers.
• Partner with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts.
• Initiate provider telephone calls regarding proposals, overcome objections, and apply effective telephone negotiation skills to reach successful resolution (up to 40% of time will be on the phone with providers).
• Meet and maintain established departmental performance metrics.
• Manage a high volume of healthcare claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.
• Handle multiple clients with varying requirements and rules.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA protocol.
• Demonstrate the company’s core competencies and values.

Knowledge of Workers' Compensation or automobile medical ("auto") claims/bills is a plus.

Requirements

• Work under general supervision, applying fundamental knowledge of principles, practices, and procedures related to negotiating healthcare claims/bills and provider agreements.
• Handle sometimes complex work requiring some independent judgment within established guidelines; refer more complex issues to higher levels.
• Regular contact with internal and external customers.

Pay

The salary range for this position is $19.97–$30.32 per hour. Specific offers consider a candidate’s education, experience, skills, work location, and internal equity.

Benefits

• Medical, dental, and vision coverage with low deductible and copay.
• Life insurance.
• Short- and long-term disability.
• 401(k) with company match.
• Generous Paid Time Off (PTO).
• Paid company holidays.
• Paid Parental Leave.
• Tuition reimbursement.
• Flexible Spending Account (FSA).
• Employee Assistance Program (EAP).
• Summer Hours.
• Bonus opportunity.
• Employee Stock Purchase Plan (ESPP).
• Mental health resources.
• Financial planning resources.
• Professional development opportunities.

About Us

At Claritev, we help make healthcare clearer and more affordable through the power of data, technology, and expertise. We offer meaningful career growth opportunities, collaboration with talented colleagues, and the chance to impact clients and communities. Our culture values innovation, agility, teamwork, ownership, and excellence.

Claritev is committed to fostering an inclusive workplace where every associate feels respected, valued, and empowered to succeed. We are an Equal Opportunity Employer and comply with all applicable laws and regulations.