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.