Call Center Investigation Specialist

Claritev•New York, NY

27d•$19

About The Position

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!!! ROLE OVERVIEW: 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.

Requirements

Minimum high school diploma and one (1) year experience in an analytic or claims environment.
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.
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.

Nice To Haves

Bachelors' degree in a relevant field is strongly preferred.
Required licensures, professional certifications, and/or Board certifications as applicable.
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).

Responsibilities

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.
Adapt to process changes and help improve and implement new processes.
Identify and develop subrogation opportunities.
Research and request case information to develop cases. Access and pull benefits from clients' remote health claim systems.
Place parties of interest on notice.
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.
Pursue worker's compensation, first and third party, med-pay coverage and no-fault recoveries.
Engage advice and/or help of Management to proactively resolve cases. Provide feedback to Management and unit on trends or developments.
Maintain department productivity and quality standards.
Collaborate, coordinate, and communicate across disciplines and departments.
Ensure compliance with HIPAA regulations and requirements.
Demonstrate Company's Core Competencies and values held within.
Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
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.

Benefits

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