Role Overview
This role is responsible for handling pre-claim and OON physician contract negotiations for all clients, reaching out to senior management at facilities across the country to secure lowest settlement rate. The position works independently under minimal supervision to complete assigned job responsibilities.
What You Will Do
Handles facility, provider, and client inquiries regarding pre-claims and OON physician contract requests; secures signed agreements for reimbursement with providers; researches claims to confirm history with the provider; determines cost-saving opportunities and pricing optimization strategies.
Why It Might Be a Fit
The ideal candidate will have a minimum high school diploma plus two years' experience in a medical healthcare claims role, with a background in healthcare claims management, negotiation experience, and strong organizational and communication skills.
Requirements
Minimum high school diploma plus two years' experience in a medical healthcare claims role
Background in healthcare claims management environment
Demonstrated negotiation experience
Proactive, self-starter
High level of professionalism, organization, and flexibility
Strong organizational skills, attention to detail
Strong communication skills, oral and written
Ability to manage high call volume
Ability to multi-task effectively
Detail focused
Self-motivating personality and professional demeanor
PC literate, including Microsoft Office products and web-based applications
Required licensures, professional certifications, and/or Board certifications as applicable 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
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits
Claritev is a healthcare technology company on a mission to simplify healthcare workflows, improve transparency, and bend the healthcare cost curve. By combining deep healthcare expertise with advanced analytics and AI, the company helps payers, providers, and employers operate more efficiently and deliver better outcomes. Claritev develops data-driven and AI-powered solutions to automate complex healthcare workflows, improve decision-making, and reduce unnecessary costs across the system. The company's platforms address areas including provider credentialing, data management, surprise bill services, and claims processing, leveraging predictive, generative, and agentic AI systems to transform healthcare operations.
