Call Center Investigation Specialist

Allgemeine Daten
Land:	USA
Stadt:	unbekannt
Arbeitgeber:	Claritev
Berufsfeld:	Customer Success
Vertragsart:	full-time
Gehalt:	ab USD

Job-Beschreibung

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!!!

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This position will take a high volume of inbound calls to process a paperless health insurance subrogation caseload by investigating potential cases and pursuing med-pay, no-fault, liability, and workers’ compensation recoveries. This position’s work environment is team-orientated. The incumbent will coordinate efforts with other members of the subrogation team to maximize recoveries.

JOB ROLES AND RESPONSIBILITIES:
1. Follow client specific procedures and guidelines. Understand basic health plan contractual provisions and apply to the reimbursement efforts. Ensure compliance of state and federal laws.
2. Adapt to process changes and help improve and implement new processes.
3. Identify and develop subrogation opportunities.
4. Research and request case information to develop cases. Access and pull benefits from clients’ remote health claim systems.
5. Place parties of interest on notice.
6. Respond timely to all electronic, written and verbal communications. Log information derived from written and verbal communication; where required maintain detailed and accurate records. Maintain a calendar diary to monitor case activity.
7. Pursue worker’s compensation, first and third party, med-pay coverage and no-fault recoveries.
8. Engage advice and/or help of Management to proactively resolve cases. Provide feedback to Management and unit on trends or developments.
9. Maintain department productivity and quality standards.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate Company’s Core Competencies and values held within.
13. Please note due to the exposure of PHI sensitive data — this role is considered to be a High Risk Role.
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:
The incumbent works under general supervision while keeping the needs of external and internal customers as a priority when making decisions and taking action. The incumbent communicates across a base of clients, members, and their employers. The successful individual in this role must be open to feedback, teamwork, and show a keen interest in contributing ideas to improve existing departmental processes. Decision making in the role is limited and must fall within established guidelines and may often end up being escalated to higher levels.

COMPENSATION

The salary range for this position is $18.50 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.

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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QualificationsJOB REQUIREMENTS (Education, Experience, and Training):* Minimum high school diploma and one (1) year experience in an analytic or claims environment. Bachelors’ degree in a relevant field is strongly preferred.
* Required licensures, professional certifications, and/or Board certifications as applicable.
* Developed customer service skills.
* Strong organizational and time management skills.
* Ability to work independently and as part of a team.
* Working knowledge of Microsoft Word, Excel, internet research skills.
* Specifications should support the essential functions identified in the job, assuring compliance with the Americans with Disabilities Act (ADA) and other such employment-related acts (i.e., ability to stand for long periods of time, ability to interact with customers or visitors, ability to lift up to 50 pounds, ability to travel).
* 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.

COMPENSATION

The salary range for this position is $18.50 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.

BENEFITS