At Claritev, we’re a bold, innovative team on a mission to bend the cost curve in healthcare for everyone. We’re committed to service excellence, supporting our internal teams, our partners, and the communities we serve with the same level of care and intention.
We are fearlessly ambitious, relentlessly curious, and united by a culture that values accountability, celebrates diversity, and empowers every voice. Together, we push boundaries, embrace new ideas, and elevate each other’s potential.
Join us on this transformational journey as we continue to grow into a leading force in healthcare technology, data, and innovation. Onward and upward, together.
ROLE SUMMARY
This role is accountable for developing cases after the initial investigation to confirm viability of subrogation cases. Moreover, the incumbent manages the coordination of claim payments among health plans, collects refunds of duplicate payments from providers, and successful recovery of 1st party funds. The role provides a final determination on all potential sources of recovery and fully prepares the cases for the Paralegals to successfully negotiate the liability claims. This role requires the incumbent be confident on the phone and comfortable interacting with insurance companies, providers, health plan members, and personal injury attorneys. JOB ROLES AND RESPONSIBILITIES
1. Review, identify, and develop subrogation opportunities by gathering missing information and potential sources of recovery. Research and analyze information gathered through continuous investigation. Record and maintain detailed and accurate records.
2. Validate claim viability and terminate pursuit when necessary; respond timely to all electronic, written and verbal communications.
3. Place parties of interest on notice and send subsequent demand letters.
4. Continuously research and make outbound calls to request case information or status to drive cases to be prepared for settlement; maintain detailed and accurate case records and calendar diaries to monitor case activities to meet department expectations.
5. Engage advice and/or help of Negotiators/Paralegals to proactively resolve and/or transfer cases.
6. Ensure compliance of state and federal laws and maintain department productivity and quality standards.
7. Take transferred calls and/or documents from inbound investigation teams to provide a resolution to the enquiry.
8. Collaborate, coordinate, and communicate across disciplines and departments.
9. Ensure compliance with HIPAA regulations and requirements.
10. Demonstrate Company’s Core Competencies and values held within.
11. Please note due to the exposure of PHI sensitive data — this role is considered to be a High Risk Role.
12. 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.
COMPENSATION
The salary range for this position is $40,458- $67,671 annually. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
JOB SCOPE This role keeps the needs of external and internal customers as a priority when making decisions and taking action. The successful incumbent operates independently under limited supervision. This role tasks the incumbent with decision making authority within specified parameters and must engage to obtain advice and/or help of legal manager, negotiator, or paralegal to proactively resolve cases. Works across customers, beneficiaries, providers, and supplemental payors while maintaining positive relationships.
QualificationsJOB REQUIREMENTS (Education, Experience, and Training)* Minimum high school diploma coupled with two (2) years’ of subrogation, collections, insurance or coordination of benefits (COB) experience. Bachelors’ degree in a relevant field in preferred.* Working knowledge of Microsoft Office and internet research skills
* Working knowledge of Microsoft Office and internet research skills
* Excellent communication skills (both verbal and written).
* Proficient with Microsoft Office and internet research skills.
* Strong organizational and time management skills with the ability to multi-task and work independently.
* Strong analytical, problem solving and decision-making skills; ability to exercise good judgment.
* Must have ability to define problems, collect data, establish facts, and draw valid conclusions.
* Required licensures, professional certifications, and/or Board certifications as applicable
* 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
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- 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
- WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional 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
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.
APPLICATION DEADLINE
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.
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