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JOB SUMMARY: This position is responsible for providing quality customer service while effectively responding to a variety of inquiries from customers while documenting all cases according to established policies and procedures. Ability to understand multiple processes, networks and systems required. JOB ROLES AND RESPONSIBILITIES:
Resolve and input provider/client requests into tracking system according to established guidelines. Assign cases accordingly. Provide customer satisfaction to both internal and external customers. Meet or exceed established standards on a consistent basis for quality, customer service, productivity and service level per department guidelines. Promote and maintain a flexible, cooperative, team oriented and customer focused attitude within and between departments, customers and vendors. Handle routine customer inquiries and assess call escalation; work with Sr and TL on resolution. Redirect calls as needed. Provide direction to providers, clients and members regarding Network Operations processes as needed. Identify trends or process improvements to gain Call Center efficiencies and Quality Assurance concerns. Assist providers with application fulfillment and status. 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.
JOB SCOPE: This job works under close supervision to complete job responsibilities. Work is prescribed and completed with very little autonomy with little discretion to vary from established policies and procedures. The incumbent relies on previous experience and judgment to support department management in completing daily activities. This job does not directly supervise other personnel. JOB REQUIREMENTS (Education, Experience, and Training):
Minimum high school diploma or GED Minimum 1 year customer service experience Call center or telephone experience in similar environment and/or industry desired Required licensures, professional certifications, and/or Board certifications as applicable Communication (written, verbal, listening) organization, telephone, and data entry skills Ability to work a flexible schedule to accommodate phone queues Ability to identify problem issues and determine the appropriate course of action/redirection within department guidelines required to resolve issues Ability to resolve issues of conflict in a tactful and professional manner and to effectively diffuse irate callers Ability to effectively handle multiple tasks, prioritize and manage time in a fast paced environment Ability to work independently as well as part of a team Ability to use software, hardware and peripherals related to job responsibilities including MS Office Suites, database software, etc. Ability to use multiple systems for claims research, contract interpretation, Fee Schedule rates, provider network status and verification, applications/nominations, and data integrity
COMPENSATION
The salary for this position is $19.00 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. #LI-MC1 Why Claritev? Healthcare is complex. We help make it clearer. At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here. What Guides Us At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.
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MultiPlan
401(k)
Oct 17, 2026