Remote New

Medical Claims Resolution Specialist II

MultiPlan
United States
Jun 17, 2025
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 contacting health care providers to negotiate certain type and dollar size health care claims/bills. Objective is to achieve maximum discounts and savings on behalf of the payor/client. JOB ROLE AND RESPONSIBILITIES: 1. Foster and maintain provider relationship to facilitate current and future negotiations by * Performing claim research to provide support for desired savings. * Generating agreements by communicating with providers by written and verbal communication throughout the negotiation process; and a. Address counteroffers received and present proposal for resolution while adhering to client guidelines and department goals. b. Seek opportunities to achieve savings with previously challenging/unsuccessful providers. * Partnering with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts as applicable. 2. Initiate provider telephone calls with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims. * Up to 40% of time will be on phone with providers. 3. Meet and maintain established departmental performance metrics. 4. Manage high volume of healthcare claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims. * Must be versatile to handle multiple clients with different requirements with different rules. * Knowledge of Workers' Compensation or automobile medical ("auto") claims/bills is a plus: 5. Collaborate, coordinate, and communicate across disciplines and departments. 6. Ensure compliance with HIPAA protocol. 7. Demonstrate Company's Core Competencies and values held within. 8. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role. 9. 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 individual in this position works under general supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the negotiation of health care claims/bills and provider agreements. Work is sometimes complex and requires some independent judgment within established guidelines. More complex issues are referred to higher levels. This job has regular contact with internal and external customers.