Claritev · 14 hours ago
Senior Claims Analyst
United States
Full-time
Onsite
Mid, Senior Level
$75K/yr - $85K/yr
2+ years expClaritev is a dynamic team of innovative professionals striving to bend the cost curve in healthcare. The Senior Claims Analyst role involves researching new concepts for development, utilizing department tools, and collaborating across disciplines to improve claims processing and ensure compliance with regulations.
BillingHealth CarePayments
Responsibilities
Researches new concepts for development to determine applicability to client requirements
Effectively utilize department tools to research concepts as appropriate, including but not limited to:
Client Claims Processing Policies/Systems
CMS/OIG/RAC Public Information
Provider/Member Contracts
State Medicaid Plans Public Information
Review of Adjustment Claims
Document new concepts in an appropriate format outlined by management
Partners with Microsoft SQL developers to develop efficient output of concept following concept development Process as Defined by Management
Communicate to management any issues that impact work performance and work with management to resolve any Issues that impact work performance
Provide appropriate feedback to management on areas of improvement
Aid in the training and mentorship of new team members as appropriate
Document how to validate overpayments at a conceptual level
Aid in the documentation of concept approval forms for clients as necessary
Collaborate, coordinate, and communicate across disciplines and departments
Ensure compliance with HIPAA regulations and requirements
Demonstrate Company's Core Competencies and values held within
Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role
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
Qualification
Required
Minimum high school diploma and two (2) years' experience as analyzing medical claims paid/processed data
Experience on Multiple Claims Processing Platforms
Experience on Multiple Clients with varying Claims Processing Policies
Experience with Various Types of Medical Health Care Claims, including but not limited to: Inpatient, Outpatient, Professional
Experience with Various Types of Medical Health Care Payment Methods, including but not limited to: DRG, Per Diem, Outpatient Surgery Groupers, RUG, OASIS, Fee Schedule
Required licensures, professional certifications, and/or Board certifications as applicable
Recognize New Concepts that Lead to Overpayments
Works Efficiently on Multiple Clients
Utilizes tools to Identify New Concepts on Data (ReThink Analyzer)
Attention to Detail
Proven Problem-Solving Abilities
Excellent Written Communication Skills
Effective Time Management Skills
Flexible During Time of Change
Highly Self-Motivated
Ability to Apply New Technologies/Techniques Quickly and Efficiently
Efficiently Adapt to Shifting Priorities/Timelines
Specifications should support the essential functions identified in the job, assuring compliance with the Americans with Disabilities Act (ADA) and other such employment-related acts (i.e., ability to stand for long periods of time, ability to interact with customers or visitors, ability to lift up to 50 pounds, ability to travel)
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
Preferred
Bachelors' degree in a relevant field of study is strongly preferred
Benefits
Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off - accrued based on years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits - 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
Company
Claritev
Claritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all.
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
$7.18B2025-11-12Post Ipo Secondary· $77.25M
2024-12-24Post Ipo Debt· $4.5B
2020-10-09Post Ipo Equity· $1.3B
Leadership Team
Travis Dalton
President & CEO Claritev
M
Mohamed Ramzy
Senior Vice President & GM International
Recent News
2026-01-06
Morningstar.com
2025-11-14
Company data provided by crunchbase