Operations Analyst 1

Operations Analyst I

 

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. By helping healthcare payers manage costs, improve competitiveness, and drive meaningful change, we create real impact across the industry.

We are a company with a 40-year legacy of delivering innovative healthcare cost management solutions. Our culture is rooted in collaboration, inclusion, and continuous improvement. At Claritev, we are where bright people come to shine.

 

Job Summary

The Operations Analyst I supports Clinical Review operations through claim research, workflow distribution, documentation processing, and operational project support. This role plays a key part in ensuring accurate claims handling, maintaining data integrity, and supporting high-volume operational processes.

 

Key Responsibilities

• Review, investigate, and analyze claim appeals, partnering with coding teams to coordinate documentation review
• Support customer service, providers, and clients by resolving claim-related inquiries and issues
• Research and manage claim inventory across inpatient, outpatient, and provider billing
• Request, track, and process documentation for clinical reviews and special projects
• Access and retrieve information from internal systems and external client platforms
• Perform data entry and maintain databases, including validation and updates to provider data
• Execute system claim adjustments based on appeal outcomes or corrected claims
• Manually distribute workflow when system automation is unavailable
• Support operational and service-related pilot projects alongside daily responsibilities
• Collaborate across departments to ensure alignment and effective communication
• Maintain compliance with HIPAA regulations and company policies
• Prioritize and manage shifting workloads in a fast-paced environment

Please note: due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.

Compensation

The salary range for this position is $40-45k annually.  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.

 

Job Scope

This role operates under general supervision, applying knowledge of claims processes and internal systems to support high-volume operational workflows. The Operations Analyst I independently resolves routine issues while escalating more complex concerns as needed. Success in this role requires strong attention to detail, adaptability, and the ability to manage multiple priorities effectively.

Qualifications

Job Requirements

• High school diploma or GED required with a minimum of two (2) years of experience in an operations or service-related role such as claims processing, customer service, medical records, collections, data entry, or database management
  • Associate’s degree may be considered in lieu of experience
• Healthcare experience and/or familiarity with medical coding concepts preferred
• Strong communication skills including written, verbal, and active listening
• Strong analytical, organizational, and prioritization skills
• Proficiency in Microsoft Office, including Word and Excel, and experience with database systems
• Ability to manage multiple tasks and adapt quickly in a fast-paced environment
• Strong technical aptitude and ability to navigate multiple systems
• Ability to identify issues and escalate appropriately
• Ability to build trust and credibility across all levels of the organization
• Ability to work independently while handling confidential information
• Flexibility to adjust schedule as needed to meet business demands

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