• Submit clean, timely claims with accurate CPT, HCPCS, ICD-10 codes, and modifiers. • Track and resolve denials, rejections, and underpayments with appropriate follow-up and resubmission. • Validate eligibility, authorization, and proper billing pathways for all patient encounters. • Ensure accurate use of telehealth, SDOH, and preventive care codes. • Coordinate with credentialing, partner success, and payer reps to ensure claims compliance. • Perform other duties as assigned. • Review provider documentation and assign accurate codes per ICD-10-CM, CPT, and HEDIS/quality reporting guidelines. • Identify and escalate incomplete documentation or coding gaps; issue coding queries as needed. • Educate providers under the guidance of the Coding Manager to drive documentation improvement. • Support implementation and testing of new documentation macros and encounter note templates. • Maintain and contribute to the internal billing rules matrix (payer, state, provider type, modifiers). • Collaborate with the Data & Analytics team to track claim trends, documentation compliance, and A/R performance. • Partner with Revenue Cycle and Clinical Ops to align workflows with payer requirements and business goals. • Support provider training, macro updates, and compliance education efforts.

Role Description The Global Logistics Specialist supports the execution of global logistics operations, ensuring the efficient and compliant movement of goods across domestic and international networks. This role partners with internal teams, carriers, and third-party providers to deliver reliable, cost-effective transportation solutions while maintaining high service levels and adherence to trade regulations. - Coordinate end-to-end domestic and international shipments, including freight forwarding, customs clearance, and final delivery - Serve as a primary point of contact for internal teams, carriers, freight forwarders, and customs brokers - Partner with suppliers, warehouses, and logistics providers to schedule and monitor shipments - Ensure compliance with international trade regulations, customs requirements, and company policies - Prepare, review, and validate shipping documentation (commercial invoices, bills of lading, certificates of origin, etc.) - Monitor shipments using tracking tools and provide proactive updates and exception management - Identify and resolve delays, discrepancies, and service issues to minimize disruption - Maintain accurate shipment records and support reporting on performance and exceptions - Provide accurate and timely freight quotes, including duties, taxes, and accessorial costs - Analyze shipment requirements and recommend efficient, cost-effective logistics solutions - Other job duties as assigned Qualifications - Minimum Required: - 2+ years of experience in logistics, transportation, or supply chain operations - 2+ years of customer service or client-facing experience - Proficiency in Microsoft Excel and Word - Familiarity with parcel and freight tracking systems - Strong attention to detail and ability to work in a fast-paced environment - Preferred: - 3+ years of related logistics experience - Knowledge of U.S. export laws - Experience with software programs relevant to logistics operations Requirements - Strong communication skills with the ability to convey information clearly and professionally - High attention to detail and accuracy - Strong time management and organizational skills - Customer-focused mindset with a proactive approach to problem-solving - Ability to manage multiple priorities and meet deadlines - Ability to collaborate across cross-functional teams and external partners Benefits - Medical, Dental, and Vision Insurance - 401(k) - Paid company holidays - Paid time off - Paid parental and caregiver leave - Plus more! See benefits here for additional details.

Role Description 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. - Draft briefs and offers persuasively documented arguments supporting client positions in arbitration packages pursuant to federal regulations. - Conduct due diligence (e.g. online research, portal and application research) to assist with the analysis and preparation of arbitration packages. - Work with other departments to develop or obtain information necessary for the submission of IDR packages. - Review and analyze clinical information along with documents submitted by providers of moderate to high complexity. - Meet federal filing deadlines and turnaround times. - Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; maintain detailed and accurate records. - Outreach to clients for data needed for arbitration packages. - Maintain department productivity and quality standards. - Sensitivity to privacy in accordance with HIPAA guidelines. - Collaborate, coordinate, and communicate across disciplines and departments. - Ensure compliance with HIPAA regulations and requirements. - Demonstrate Company's Core Competencies and values held within. - 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. Qualifications - Minimum high school diploma or equivalent (GED) and four (4) years' experience in healthcare operations. Bachelor's 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 - 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. - 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. 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.

Role Description This position is a fully remote opportunity with a schedule from Monday to Friday, 8:00 AM to 5:00 PM CST. There may be occasional weekend or extended hours to meet contract deadlines or urgent requirements, and some flexibility will be needed for holiday coverage depending on business needs. Candidates should have prior experience in a dental or medical setting, along with a strong understanding of healthcare terminology. Medicare/Medicaid experience is strongly preferred. Key responsibilities include: - Act as a main point of contact and subject matter expert for receiving and resolving standard and complex internal and external appeals and complaints. - Provide proactive communication to internal and external team members to reduce escalations and ensure efficient operations. - Analyze, triage, investigate, research, and process standard and escalated appeals, complaints, or state complaints. - Assist internal departments and clients with escalated provider and member concerns. - Act as a liaison between the appeals department and clients for escalated or complex issues. - Serve as a primary resource for department projects and technical support for appeals and complaints processing. - Complete or drive participation in root cause analysis and trending for all activity in assigned markets. - Document all appeal, complaint, and grievance activity for reporting and trending analysis. - Create formal correspondence to confirm receipt and provide resolution for member and provider complaints. - Work collaboratively with internal departments to maintain effective relationships. - Collaborate with ACG IV in training new team members. - Maintain strict compliance turnaround times. - Update Supervisor on significant issues, trends, and potential risk areas. - Utilize effective diffusion techniques to resolve internal and external conflicts. - Assist with job aid creation, training materials, and reporting requirements. - Update resources to maintain current knowledge of dental plans and departmental processes. - Participate in client audits and URAC preparedness. - Act as a backup for department functions as necessary. - Provide information and guidance for incoming call center escalations. - Provide regular feedback about processes and system usage to management. - Conduct quality reviews of new staff when acting as preceptor. Qualifications - High school diploma or equivalent required. - 2+ years of complaints, appeals, and grievances processing for a managed care program or related experience. - Advanced knowledge in MS Word, Excel, and Outlook. - Ability to compose communication letters efficiently and accurately. - Ability to work through challenging issues in a professional manner. - Accurate inventory management, data entry, time management, and typing skills. - Demonstrated attention to detail. - Effective communication skills in a remote environment. Requirements - Post-secondary education in a related field preferred. - Previous appeals experience in healthcare preferred. - 2+ years of related experience such as dental front office, health/dental insurance, or managed care operations preferred. - Previous experience in a leadership role preferred. - Previous experience working with Medicare/Medicaid preferred. Benefits - Fully remote work environment. - Flexible schedule with potential for holiday coverage.