Qureos Mentor

Claritev

<div><h1 class="jobSectionHeader">Operations Analyst
</h1>At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders &ndash; internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
<h2 class="jobSectionHeader">JOB SUMMARY
</h2>This position assists with workflow distribution, claim research, documentation processing, and operational/service pilot projects in support of Clinical Review operations.
<h2 class="jobSectionHeader">DUTIES
</h2><div><ul><li>Review, investigate, and analyze claim appeals, working closely with coders to coordinate review of documentation. Assist customer service, providers, and clients on resolution of issues or inquiries.</li></ul>
<ul><li>Research and manage claim inventory for inpatient, outpatient, and provider billing using review guidance supplied by our clinical teams.</li></ul>
<ul><li>Request and process documentation associated with special projects and clinical review inquiries.</li></ul>
<ul><li>Access, research, and retrieve information and documentation from Claritev and one of various external client systems.</li></ul>
<ul><li>Data entry and database maintenance including review, validation, and maintenance of provider data.</li></ul>
<ul><li>Perform system claim adjustments based on appeal outcomes or to process corrected claims.</li></ul>
<ul><li>Manage manual distribution of workflow when system is unable to assign.</li></ul>
<ul><li>Assist with special projects as assigned in conjunction with daily workload; prioritizing and shifting focus as needed.</li></ul>
<ul><li>Collaborate, coordinate, and communicate across disciplines and departments.</li></ul>
<ul><li>Ensure compliance with HIPAA regulations and requirements.</li></ul>
<ul><li>Demonstrate Company&rsquo;s core competencies and values.</li></ul>
<ul><li>Please note: due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.</li></ul>
<ul><li>The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.</li></ul>
</div><h2 class="jobSectionHeader">COMPENSATION
</h2>The salary for this position is $50,000. Specific offers take into account a candidate&rsquo;s education, experience and skills, as well as the candidate&rsquo;s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.</div>
 <div>Requirements: REQUIREMENTS 
Minimum high school diploma or GED along with two (2) years of experience in an operations and/or service role such as claims processing, customer service, medical records, collections, data entry, or database management. Associate's degree accepted without prior experience. 
Experience in health care and/or knowledge of commonly used medical coding preferred. 
Required licensures, professional certifications, and/or Board certifications as applicable. 
Communication (written, verbal and listening), analytical, organizational, prioritization, technical, etiquette and interpersonal skills. 
Ability to use software and hardware peripherals related to job responsibilities including MS Office Suites with preferred proficiency with Word, Excel, and other database software. 
Ability to be flexible in quickly shifting priorities and keeping up with changes across multiple tasks in a fast-paced environment while maintaining a positive and cooperative demeanor. 
Ability to demonstrate strong technical skills. 
Ability to identify issues and escalate for course of action for resolution. 
Ability to elicit trust and credibility with all levels of the organization. 
Ability to adjust or alter schedule to meet deadlines. 
Ability to work independently and handle confidential information. 
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitors for extended periods of time, operating standard office equipment such as a keyboard, copier and telephone. 
BENEFITS 
 
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities. 
 
Your benefits will include: 
 
Medical, dental and vision coverage with low deductible &amp; copay 
 
Life insurance 
 
Short and long-term disability 
 
Paid Parental Leave 
 
401(k) + match 
 
Employee Stock Purchase Plan 
 
Generous Paid Time Off &ndash; accrued based on years of service 
 
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service 
 
10 paid company holidays 
 
Tuition reimbursement 
 
Flexible Spending Account 
 
Employee Assistance Program 
 
Sick time benefits &ndash; for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits 
 
EEO STATEMENT 
 
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, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. 
 
APPLICATION DEADLINE 
 
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted. 
 
#LI-KB1</div>

Operations Analyst

<div><div>At Claritev, our mission is to simplify healthcare workflows, improve transparency, and bend the healthcare cost curve . We believe that data, technology, and AI can fundamentally transform how healthcare operates by automating complex workflows, improving decision-making, and reducing unnecessary costs across the system.
By combining deep healthcare expertise with advanced analytics and AI, we help payers, providers, and employers operate more efficiently and deliver better outcomes for the people they serve.
We are bold in our thinking, rigorous in execution, and committed to service excellence for every stakeholder. Our culture values innovation, accountability, diversity of thought, and collaboration.
Join us as we accelerate our transformation into a leading technology and AI-driven company shaping the future of healthcare.
JOB SUMMARY:
We are seeking a Lead Applied Scientist to lead the research, development, and deployment of advanced machine learning and AI systems that power Claritev&rsquo;s next generation of healthcare products.
This is a hands-on technical leadership role for an experienced applied scientist who thrives at the intersection of research innovation, real-world deployment, and measurable business impact . You will architect and deliver predictive, generative, and agentic AI systems that automate complex healthcare workflows and unlock new insights from large-scale healthcare data.
In this role, you will work closely with Product, Engineering, and business leaders to translate cutting-edge research into scalable production solutions that improve transparency, reduce costs, and simplify healthcare operations.
You will also serve as a technical thought leader and mentor , helping shape Claritev&rsquo;s AI strategy and elevating the scientific rigor and innovation of the organization.
KEY RESPONSIBILITIES:
 
AI &amp; Machine Learning Leadership
<ul><li>Lead the research, design, and deployment of machine learning and AI systems in production environments.</li>
<li>Architect predictive, generative, and optimization models that drive healthcare cost reduction, transparency, and operational efficiency.</li>
<li>Develop advanced analytics, forecasting, and decision-support models that improve customer and client outcomes.</li>
</ul>Innovation &amp; Applied Research
<ul><li>Research and evaluate emerging AI technologies, foundation models, and agentic systems to identify opportunities for new products and capabilities.</li>
<li>Design and implement novel machine learning and optimization methodologies tailored to complex healthcare data and workflows.</li>
<li>Drive experimentation and rapid prototyping to accelerate innovation and product development.</li>
</ul>Product &amp; Business Impact
<ul><li>Partner with Product, Engineering, and business stakeholders to translate AI capabilities into scalable solutions.</li>
<li>Identify opportunities to leverage Claritev&rsquo;s data assets to create new AI-driven products, insights, and automation capabilities .</li>
<li>Collaborate directly with clients to gather feedback and ensure solutions deliver measurable value.</li>
</ul>Engineering &amp; Production Excellence
<ul><li>Write high-quality, scalable, and production-ready code .</li>
<li>Work closely with Engineering and DevOps teams to deploy and maintain models in production systems.</li>
<li>Develop monitoring frameworks to ensure model performance, reliability, and data quality over time.</li>
</ul>Collaboration &amp; Mentorship
<ul><li>Serve as a technical mentor and leader for applied scientists and data scientists.</li>
<li>Foster a culture of scientific rigor, experimentation, and knowledge sharing .</li>
<li>Collaborate across disciplines including product management, engineering, analytics, and operations.</li>
</ul>Governance &amp; Compliance
<ul><li>Ensure compliance with HIPAA and healthcare data privacy regulations .</li>
<li>Implement responsible AI practices including model validation, monitoring, and risk management .</li></ul></div></div><div></div>
 <div>Requirements: JOB REQUIREMENTS 
 
Ph.D. or M.S. in Computer Science, Statistics, Applied Mathematics, Data Science, or a related field. 
5+ years of hands-on industry experience applying Machine Learning (ML), Predictive Modeling, or Generative/Agentic AI in industry, with a proven track record of delivering solutions from prototype to production. 
1-2 years of hands-on experience with Generative AI and agent development. 
Healthcare or health services experience is a plus 
Strong proficiency in Python, deep learning frameworks (e.g., PyTorch, TensorFlow), and agentic frameworks (e.g. LangChain, LangGraph, Autogen, crewAI, n8n). 
Expertise in designing and implementing RAG pipelines, and integrating planning, memory, tools, MCP, and A2A protocol for agent workflows. 
Experience in building evaluation pipelines for LLM and agent performance, including metrics such as accuracy, reliability, and latency. 
Proficiency in using AI Coding tools like Github Copilot, OpenAI Codex etc. 
Strong foundation in ML theory, including deep learning, statistics, or optimization. 
A product-oriented mindset , with the ability to align applied science work with business objectives and impact. 
Excellent communication and cross-functional collaboration skills. 
 
COMPENSATION 
 
The salary range for this position is $150K to $170K. Specific compensation offers are determined based on a variety of factors including the candidate&rsquo;s education, experience, skills, work location, and internal equity considerations In addition to base salary, this position is eligible for an annual performance bonus and a comprehensive benefits package, including health insurance and a 401(k) retirement plan. 
 
BENEFITS 
 
We realize that our employees are instrumental in our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities. 
 
Your benefits will include: 
 
Medical, dental and vision coverage with low deductible &amp; copay 
Life insurance 
Short and long-term disability 
Paid Parental Leave 
401(k) + match 
Employee Stock Purchase Plan 
Generous Paid Time Off &ndash; accrued based on years of service 
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service 
10 paid company holidays 
Tuition reimbursement 
Flexible Spending Account 
Employee Assistance Program 
Sick time benefits &ndash; for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits. 
 
EEO STATEMENT 
 
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, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, . 
 
APPLICATION DEADLINE 
 
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted. 
 
#LI &ndash; VG1</div>

Lead Applied Scientist

<div>Sr Medical Claims Investigator- Coordination of Benefits
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders &ndash; internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
JOB SUMMARY
 
This role reviews medical paid claims against provider contracts and policies to ensure medical payments have been processed accurately. The incumbent will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments. The incumbent will assist department leadership in managing productivity and achieving quality and revenue goals, as well as mentoring more junior department team members when appropriate.
DUTIES
<div><ul><li>Achieve measured production, quality, and growth results.</li></ul>
<ul><li>Utilize analytics, data mining and coordination of benefit techniques to client paid claims data, develop creative and innovative algorithms and queries that facilitate identification of new savings opportunities.</li></ul>
<ul><li>Evaluate medical claims for coding and pricing errors using accurate HCPCS, ICD-10, and CPT codes.</li></ul>
<ul><li>Research coding rules and guidelines in support of internal and external pre-pay edits.</li></ul>
<ul><li>Lookup and review medical claims in payer systems to determine methods of payment and validate savings identified.</li></ul>
<ul><li>Provide coding expertise on reimbursement policy, provider contractor investigations, and prepay editing topics.</li></ul>
<ul><li>Represent the team in payment policy discussions when necessary, and document new policies or modifications to existing policies.</li></ul>
<ul><li>Act as a subject matter expert using internal and external tools in order to complete audits and provide guidance to team members.</li></ul>
<ul><li>Aid in the training and peer review of others in the department for data mining, coordination of benefits, and auditing best practices.</li></ul>
<ul><li>Act as a mentor by answering questions regarding contracts, policies, and medical coding.</li></ul>
<ul><li>Assist in provider collection efforts and appeal resolution as needed.</li></ul>
<ul><li>Prepare comprehensive overpayment white papers and present to clients.</li></ul>
<ul><li>Utilize official coding guidelines and resources as required, including CMS directives and bulletins.</li></ul>
<ul><li>Collaborate, coordinate, and communicate across disciplines and departments.</li></ul>
<ul><li>Ensure compliance with HIPAA regulations and requirements.</li></ul>
<ul><li>Demonstrate Company&rsquo;s core competencies and values.</li></ul>
<ul><li>Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.</li></ul>
<ul><li>The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.</li></ul>
</div>JOB SCOPE
 
This role keeps the needs of external and internal customers as a priority when making decisions and taking action. The incumbent will work under limited supervision to uncover actionable claims which facilitate savings for customers. The role may require regular interaction with all levels of customers and internal staff in the organization.
COMPENSATION
 
The salary range for this position is $55,000 &ndash; $66,000. Specific offers take into account a candidate&rsquo;s education, experience and skills, as well as the candidate&rsquo;s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.</div>
 <div>Requirements: REQUIREMENTS 
 
Minimum high school diploma or GED along with four (4) years of direct experience in medical claims investigation or data mining / coordination of benefits auditing. Attainment of relevant medical billing and coding certification along with a bachelor's degree in a relevant field are both highly preferred. 
Advanced knowledge of coding type edits and medical claim reimbursement structures and methodologies. 
Advanced proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices. 
Expertise in COB NAIC Guidelines. 
Extensive experience in applying principles of coding guidelines, federal and state regulations, and policies pertaining to coding and billing. 
Subject matter expert in reviewing and interpreting medium to complex medical contracts. 
Experience providing guidance to other employees on coding regulations and reimbursement structures. 
Extensive knowledge in researching state and federal healthcare guidelines, including Medicare and State Medicaid programs. 
Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (i.e., Facets, QNXT, etc.). 
Advanced computer skills and proficiency with Microsoft Excel. 
Must be able to prioritize, coordinate, multitask, think outside the box, and be energetic. 
Must be able to work independently while maintaining close attention to detail. 
Required licensures, professional certifications, and/or Board certifications as applicable. 
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone. 
 
BENEFITS 
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities. 
 
Your benefits will include: 
&middot; Medical, dental and vision coverage with low deductible &amp; copay 
&middot; Life insurance 
&middot; Short and long-term disability 
&middot; Paid Parental Leave 
&middot; 401(k) + match 
&middot; Employee Stock Purchase Plan 
&middot; Generous Paid Time Off &ndash; accrued based on years of service 
&middot; WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service 
&middot; 10 paid company holidays 
&middot; Tuition reimbursement 
&middot; Flexible Spending Account 
&middot; Employee Assistance Program 
&middot; Sick time benefits &ndash; for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits 
 
EEO STATEMENT 
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, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, . 
 
APPLICATION DEADLINE 
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted. 
 
#LI-KB1</div>

Sr Medical Claims Investigator- Coordination of Benefits

<div>Clinical Operations Manager
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders &ndash; internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! 
JOB SUMMARY
 
The Clinical Operations Manager is responsible for leading and managing clinical operations staff, ensuring accurate and timely review of complex claims by applying clinical knowledge, coding standards, industry expertise, and federal regulations. This role oversees daily operations, supports quality and compliance initiatives, and drives performance to meet client expectations and service level agreements. The incumbent will also provide guidance, training, and mentorship to clinical staff while supporting process improvements and operational efficiencies. 
DUTIES
<ul><li>Leads, manages, and develops clinical operations staff, including coding and nursing personnel.</li>
<li>Oversees the review and analysis of complex claims to ensure accuracy, compliance, and adherence to billing standards.</li>
<li>Monitors team performance to ensure productivity, quality, and service level agreements (SLAs) are met.</li>
<li>Provides coaching, training, and mentorship to team members to support development and performance improvement.</li>
<li>Partners with leadership to identify process improvements and implement operational efficiencies.</li>
<li>Ensures compliance with federal regulations, coding standards, and internal policies.</li>
<li>Reviews and analyzes data to identify trends, issues, and opportunities for improvement.</li>
<li>Collaborates with cross-functional teams and stakeholders to support operational goals and client needs.</li>
<li>Supports audits, reporting, and escalation management as needed.</li>
<li>Maintains a high level of customer service and professionalism in all interactions.</li>
</ul>COMPENSATION
 
The salary range for this position is $100,000 &ndash; $120,000. Specific offers take into account a candidate&rsquo;s education, experience and skills, as well as the candidate&rsquo;s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.</div>
 <div>Requirements: REQUIREMENTS 
 
Minimum high school diploma. Bachelor's degree in healthcare, business, or related field preferred. International education or training is a plus. 
Minimum 7 years' experience in a clinically related field including but not limited to: complex hospital and medical billing procedures and coding, auditing, nursing, radiology, laboratory, pharmacy, or a physician assistant position. 
Minimum 4 years' leadership role with people management responsibilities, including managing remote or international teams. 
Extensive knowledge of inpatient/outpatient hospital billing and claims data including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APCs, including international coding systems (e.g., KSA, ICD-10-AM, SNOMED). 
Knowledge of Workers' Compensation, Auto, Medicare and government-sponsored programs (such as Medicare or Medicaid). 
Knowledge of provider billing and collection practices and international payer systems. 
Teaching, mentoring and presentation skills and experience. 
Strong communication, managerial, interpersonal, organizational, time management, problem-solving, and leadership skills, with cross-cultural competence. 
Ability to commit to providing a level of customer service within established standards. 
Ability to analyze data and arrive at a logical conclusion. 
Ability to identify issues and determine appropriate course of action for resolution. 
Professional demeanor, proper etiquette, and cultural sensitivity in all communications. 
Ability to elicit trust and credibility with all levels of the organization. 
Ability to use software and hardware related to job responsibilities, including MS Office Suite, online coding tools, and database software. 
Ability to work with accuracy in a fast-paced environment. 
Ability to adjust/alter workflow to meet deadlines. 
Ability to manage highly trained clinical coding and nursing personnel. 
Ability to work collegially with healthcare professionals, including physicians. 
Ability to work independently and handle confidential information. 
Ability to process detailed verbal and written instructions. 
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone. 
 
BENEFITS 
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities. 
 
Your benefits will include: 
&middot; Medical, dental and vision coverage with low deductible &amp; copay 
&middot; Life insurance 
&middot; Short and long-term disability 
&middot; Paid Parental Leave 
&middot; 401(k) + match 
&middot; Employee Stock Purchase Plan 
&middot; Generous Paid Time Off &ndash; accrued based on years of service 
&middot; WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service 
&middot; 10 paid company holidays 
&middot; Tuition reimbursement 
&middot; Flexible Spending Account 
&middot; Employee Assistance Program 
&middot; Sick time benefits &ndash; for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits 
 
EEO STATEMENT 
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, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, . 
 
APPLICATION DEADLINE 
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted. 
 
#LI-KB1</div>

Clinical Operations Manager

<div></div><div><div><div><div>Claims Resolution Specialist II 
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders &ndash; internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! 
JOB SUMMARY
This position is responsible for contacting healthcare providers to discuss negotiations for a specific dollar range of eligible claims/bills prior to payment, in order to achieve maximum discounts and savings on behalf of payor/client. 
DUTIES 
<div><ul><li>Manage a high volume of healthcare claims thoroughly to maximize savings opportunities on each claim within the established department production standards and individual goals by contacting provider on all assigned claims and presenting a proposal while maintaining high quality standards.
 
<ul><li>Perform provider research to provide support for desired savings.
</li><li>Address counteroffers received and present proposal for resolution while adhering to client guidelines and policy and procedures.
</li><li>Seek opportunities to achieve savings with previously challenging/unsuccessful providers.
</li><li>Seek opportunities to establish ongoing global or concurrent agreements for future claims.
</li><li>Update provider data base for reference and claims processing on subsequent claims.
</li></ul>2. Initiate provider telephone calls as often required with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.
 
<ul><li>Up to 40% of time will be on phone with providers.
</li><li>Provider education to providers online provider portal services available for proposal review and approval
</li></ul>3. Meet and maintain established departmental performance metrics.
 
4. Handle post claim closure service inquires, including payment status and defending original negotiation terms.
 
5. May require ACD phone responsibilities and tracking outcomes.
 
6. Collaborate, coordinate, and communicate across disciplines and departments.
 
7. Ensure compliance with HIPAA protocol.
 
8. Demonstrate Company's Core Competencies and values held within.
 
9. Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role.
 
10. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.</li></ul> 
</div>JOB SCOPE: The Individual adheres to company policies and customer specific procedures to meet control standards. The Individual relies on established instructions and procedures, applies basic skills, and may develop advanced skills using tools and equipment appropriate for the position. Duties and tasks are standardized and generally contain written instructions, allowing an individual to resolve routine questions and problems, and referring more complex issues to a higher level. Work is subject to defined work output standards and production which involves high volume claims resolution. Work involves direct contact with internal and external customers. 
COMPENSATION
The salary range for this position is $21.12 per hour. Specific offers take into account a candidate&rsquo;s education, experience and skills, as well as the candidate&rsquo;s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.</div></div></div></div><div></div>
 <div>Requirements: REQUIREMENTS 
 
* Minimum high school diploma or GED 
* Minimum 6 months experience in the health care industry (provider billing, medical coding, provider collections, insurance, or managed care); 1 year preferred. 
* State licensure certification, including NY Health and/or P&amp;C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, within six months of notification. If the required state licensure certification(s) are not obtained or renewed within six months of notification, an employee may be moved to a position within a relevant job family that does not require certification/licensure, if and when such position is available. When an alternate position is unavailable, other employment actions may be implemented consistent with Claritev practice and policy. 
* Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical (&quot;auto&quot;) bills a plus 
* Knowledge of general office operations and/or experience with standard medical insurance claim forms 
* Good Communication (verbal, written and listening) teamwork, negotiation, and organizational skills. 
o Ability to process verbal and written instructions. 
o Display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone in a business professional environment. 
* Ability to: 
o Commit to providing a level of customer service within established standards. 
o Provide attention to detail to ensure accuracy including mathematical calculations. 
o Identify issues and determine appropriate course of action for resolution. 
o Organize workload to meet deadlines and participate in department/team meetings. 
o Adjust/alter workflow to meet deadlines in a fast-paced environment. 
o Work independently and handle confidential information. 
* Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software. 
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone. 
 
BENEFITS 
 
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities. 
 
Your benefits will include: 
 
Medical, dental and vision coverage with low deductible &amp; copay 
Life insurance 
Short and long-term disability 
Paid Parental Leave 
401(k) + match 
Employee Stock Purchase Plan 
Generous Paid Time Off &ndash; accrued based on years of service 
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service 
10 paid company holidays 
Tuition reimbursement 
Flexible Spending Account 
Employee Assistance Program 
Sick time benefits &ndash; for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits 
 
EEO STATEMENT 
 
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, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, . 
 
APPLICATION DEADLINE 
 
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.</div>

Claims Resolution Specialist II