[Remote] Senior Claims Analyst

Note: The job is a remote job and is open to candidates in USA. Claritev is a dynamic team of innovative professionals focused on bending the cost curve in healthcare. The Senior Claims Analyst role involves researching new concepts for development, training team members, and ensuring compliance with regulations while collaborating across departments.ResponsibilitiesResearches new concepts for development to determine applicability to client requirementsEffectively 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 ClaimsDocument new concepts in an appropriate format outlined by managementPartner with Microsoft SQL developers to develop efficient output of concepts following the concept development process as defined by managementCommunicate to management any issues that impact work performance and work with management to resolve themProvide appropriate feedback to management on areas of improvementAid in the training and mentorship of new team members as appropriateDocument how to validate overpayments at a conceptual levelAid in the documentation of concept approval forms for clients as necessaryCollaborate, coordinate, and communicate across disciplines and departmentsEnsure compliance with HIPAA regulations and requirementsDemonstrate company core competencies and valuesDue to exposure of PHI sensitive data, this role is considered a High Risk RoleOther duties, responsibilities, and qualifications may be required and/or assigned as necessarySkillsMinimum high school diploma and two (2) years' experience analyzing medical claims paid/processed dataExperience on multiple claims processing platformsExperience working across multiple clients with varying claims processing policiesExperience with various types of medical healthcare claims, including: Inpatient, Outpatient, ProfessionalExperience with various types of medical healthcare payment methods, including: DRG, Per Diem, Outpatient Surgery Groupers, RUG, OASIS, Fee ScheduleRequired licensures, professional certifications, and/or board certifications as applicableAbility to recognize new concepts that lead to overpaymentsAbility to work efficiently across multiple clientsExperience utilizing tools to identify new concepts on data (ReThink Analyzer)Strong attention to detail and proven problem-solving abilitiesExcellent written communication skillsEffective time management skillsFlexibility during times of changeHighly self-motivatedAbility to quickly apply new technologies/techniques and adapt to shifting priorities and timelinesAbility to work in a standard office environment, including prolonged sitting, use of monitors, and standard office equipmentAbility to meet physical and environmental job requirements in compliance with ADA and other employment regulationsBachelor's degree in a relevant field of study is strongly preferredBenefitsMedical, dental and vision coverage with low deductible & copayLife insuranceShort and long-term disabilityPaid Parental Leave401(k) + matchEmployee Stock Purchase PlanGenerous Paid Time Off - accrued based on years of service10 paid company holidaysTuition reimbursementFlexible Spending AccountEmployee Assistance ProgramSick 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 otherwise required by state lawCompany OverviewClaritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all. It was founded in 1980, and is headquartered in Mclean, Virginia, USA, with a workforce of 1001-5000 employees. Its website is https://www.claritev.com/.