Sr. Customer Specialist

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY: This position is responsible for the handling, research, and communication regarding complex and escalated claims inquiries stemming from patients, clients, providers, and internal customers', including both intake and resolution. In addition, this position is also responsible for coaching and mentoring. The incumbent works under minimal supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the servicing of inquiries and providing resolution and follow-up, where necessary. Work is complex and requires independent judgment within established guidelines; however, may seek guidance from management as needed. This job has regular contact with external and internal customers. Individual may act as a primary contact for priority clients. While this is not a supervisory job, an incumbent acts as a resource to the Team and may provide input to management on training recommendations.

DUTIES:
1. Investigate, analyze, research, and resolve complex and escalated claim inquiries from patients, clients, providers, and internal customers' as a result of issues related to discounts, payments and balance billing. This includes handling legal inquiries or department of insurance complaints.
2. Provide resolution and closure to the applicable recipients. Create and execute business correspondence to clients or providers using multiple media formats such as but not limited to emails, form letters, and issues specific letters. This includes initiating resolution and follow up calls to clients and providers.
3. Adhere to client turn around requirements as it relates to response time and required actions.
4. Ensure investigative notes related to any contact with providers and clients are documented and accessible throughout the applicable systems.
5. Ensure the maintenance of and compliance with department standards for production, accuracy, and turnaround time.
6. Perform system claim adjustments based on outcomes and communicate with client regarding confirmation.
7. Assume and resolve escalated claim and inquiries from team members. Serves as back-up for team members, or Leadership.
8. Coach and mentor less experienced team members on claims handling, resource utilization, and appropriate resolutions.
9. May include call center responsibilities, including adhering to call center standards.
10. Assist in training new team members as needed and providing feedback to Leadership.
11. Various research projects for Sr. Management and Clients, as assigned.
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate Company's Core Competencies and values held within.
15. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
16. 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 $20.20. 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.