Claims Resolution Specialist I

What You'll Do

In this role, you will have the opportunity to:

• Negotiate healthcare claims and medical bills with providers to achieve maximum savings on behalf of clients.
• Build and strengthen provider relationships to support successful negotiations and future cost-containment opportunities.
• Analyze claim details and supporting documentation to develop effective negotiation strategies and substantiate settlement proposals.
• Resolve provider objections and counteroffers while balancing client guidelines, business objectives, and relationship management.
• Manage a high-volume inventory of claims, ensuring timely action, accurate documentation, and compliance with client deadlines.
• Collaborate with internal teams, including Account Management, Customer Relations, Provider Services, and client contacts, to drive successful claim outcomes.
• Identify opportunities to achieve savings with challenging or previously unsuccessful providers through creative negotiation approaches.
• Maintain compliance with HIPAA requirements and consistently achieve departmental quality, productivity, and savings goals.

What You Will Bring

Required Qualifications

• High School Diploma or GED required; Associate's or Bachelor's degree preferred.
• 6+ months of experience in healthcare, insurance claims, collections, customer service, negotiations, medical billing, or a related field.
• Strong verbal and written communication skills with the ability to influence outcomes and build professional relationships.
• Proven ability to manage multiple priorities in a high-volume, deadline-driven environment.
• Strong analytical, problem-solving, and organizational skills.
• Proficiency with Microsoft Office applications and data-entry systems.
• Ability to exercise sound judgment and make decisions within established guidelines.
• Ability to handle Protected Health Information (PHI) with the highest level of confidentiality and professionalism.

Preferred Qualifications

• Experience negotiating healthcare claims, medical bills, provider agreements, or reimbursement-related transactions.
• Knowledge of healthcare reimbursement methodologies, medical billing practices, Workers' Compensation, and/or Automobile Medical (Auto) claims.
• Experience working within a healthcare, insurance, managed care, cost-containment, or revenue cycle environment.
• Familiarity with HIPAA regulations and healthcare compliance requirements.
• Demonstrated success achieving performance metrics related to savings, productivity, quality, or customer satisfaction.

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.

In addition, this position is eligible for health insurance, a 401(k) plan, and bonus opportunities.

Due to exposure to Protected Health Information (PHI), this role is designated as a High Risk Role and requires strict adherence to HIPAA, privacy, security, and confidentiality standards.

The responsibilities described above are not intended to be an exhaustive list. Additional duties may be assigned as business needs require.

Benefits

We recognize that our employees are instrumental to our success and offer a competitive total rewards package that supports personal and professional well-being, including:

• Medical, Dental, and Vision Coverage
• Life Insurance
• Short-Term and Long-Term Disability
• 401(k) with Company Match
• Generous Paid Time Off
• Paid Company Holidays
• Paid Parental Leave
• Tuition Reimbursement
• Flexible Spending Account (FSA)
• Employee Assistance Program (EAP)
• Summer Hours
• Professional Development and Educational Programs
• Employee Recognition and Awards Programs

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Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.