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Dispute Resolution Specialist II

Claritev -
Remote

Apply Now

Job Details

Full-time
$19 - $21 an hour

Benefits

Paid parental leave
Employee stock purchase plan
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Parental leave
Employee assistance program
Vision insurance
401(k) matching
Opportunities for advancement
Flexible schedule
Life insurance

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
High school diploma or GED

Full Job Description

Dispute Resolution Specialist II

Pay range $19-21

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 role manages an arbitration case load including evaluation of provider disputes and appropriate client payment offers. This position is responsible for successful analysis and resolution of the most complex escalated issues. The incumbent will coordinate efforts with the team and leadership to bring matters to efficient and successful outcomes. The incumbent's primary responsibility will be to oversee and manage the intake, processing and coordination of all materials and information relating to the Independent Dispute Resolution ("IDR") as regulated by Federal or State law.

DUTIES

Assume primary responsibility for determining appropriate amount of client plan arbitration offers.
2. Draft briefs and offers persuasively documented arguments supporting client positions in arbitration packages pursuant to federal regulations.
3. Conduct due diligence (e.g. online research, portal and application research) to assist with the analysis and preparation of arbitration packages.
4. Works with other departments to develop or obtain information necessary for the submission of IDR packages.
5. Review and analyze clinical information along with documents submitted by providers of moderate to high complexity.
6. Meet federal filing deadlines and turnaround times
7. Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; maintain detailed and accurate records.
8. Outreach to clients for data needed for arbitration packages
9. Maintain department productivity and quality standards
10. Sensitivity to privacy in accordance with HIPAA guidelines
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate Company's Core Competencies and values held within.
14. 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.

JOB SCOPE :
Keep the needs of external and internal customers as a priority when making decisions and taking action. Operate independently under limited supervision. Has decision making authority to determine the appropriate amount of clients' offers and drafting of briefs. Works across customers, beneficiaries, providers, and supplemental payors while maintaining positive relationships.

COMPENSATION

The salary range for this position is $19-21 per hour. 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.

Requirements: REQUIREMENTS

* Minimum high school diploma or equivalent (GED) and four (4) years' experience in healthcare operations. Bachelors' degree in a related field is preferred.
* Excellent organizational, analytical and independent decision-making skills
* Demonstrated problem solving skills with the ability to manage multiple priorities and meet associated timelines
* Ability to anticipate needs and solve problems proactively in a fast paced, rapidly changing environment
* Sound business judgement
* Ability to learn quickly and work independently within time constraints
* Adept knowledge of Microsoft Word, Excel and Outlook
* Logical, clear and concise written and verbal communication skills
* 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, .

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.

Apply Now

Refine Your Search

Records Specialist Ii jobs

Dispute Resolution Specialist II

Asset Integrity Specialist I, II or III

Contracts Specialist II

Talent Acquisition Experience Specialist II

Contract Closeout Specialist

Payment Operations Specialist

Helpdesk Customer Support

QA Specialist II

Individual Disability Claims Specialist II

Accounts Receivable Specialist II

Documentation Specialist

Eligibility Specialist II

Peer Support Specialist II - Part Time

Claims Specialist II

Records Management Specialist II

Administrative Program Specialist I, II & III

Medical Records Technician II (Certified)

Contract Specialist II, Federal Acquisition Support

Policy Management ERM Specialist

Cardiovascular Tech II

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