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Operations Analyst, I

Claritev
Remote, USA
Full-time
Mid
Remote
Discovered 2 weeks ago

Full Job Posting

Required Qualifications

  • 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 escalate 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. #LI-AN1
  • 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.

Responsibilities

  • 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

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