(Remote – U.S.)
🧾 About the Role
Claritev is seeking a Payment Integrity Medical Investigator to audit claims, identify payment errors, and contribute to healthcare cost savings. This role is perfect for detail-obsessed professionals with experience in data mining, medical billing, or claims investigation who want to make a measurable impact.
✅ Position Highlights
• $21–$25 per hour (depending on experience)
• Full-time, remote (U.S. only)
• Eligible for health benefits, 401(k), and bonus opportunities
• Stable role with growth potential at an innovation-driven company
• Collaborative and mission-focused culture
📋 What You’ll Own
• Review medical paid claims for contract and policy compliance
• Analyze claims using data mining and COB (Coordination of Benefits) techniques
• Audit claims for coding/pricing errors (HCPCS, ICD-10, CPT)
• Validate savings and reimbursement accuracy
• Investigate claim history and payment methodology
• Work closely with internal teams to meet performance goals
• Research CMS and federal/state healthcare policies
• Maintain HIPAA compliance and data integrity
🎯 Must-Have Traits
• High school diploma or GED required (Bachelor’s or billing/coding cert preferred)
• 2+ years of experience in medical claims investigation or COB auditing
• Strong knowledge of medical coding (ICD-10, CPT, HCPCS) and payer systems
• Proficient in Excel and able to handle large datasets
• Detail-oriented, analytical, and able to work independently
• Familiarity with Medicare/Medicaid policies and claim reimbursement structures
• Strong time management and multitasking skills
• Comfortable working in a secure, PHI-sensitive remote environment
💻 Remote Requirements
• Reliable internet connection
• Quiet, dedicated home office setup
• U.S.-based only
• Ability to work standard business hours aligned to your time zone
💡 Why It’s a Win for Remote Job Seekers
• Meaningful work that helps reduce healthcare costs
• Competitive hourly pay with full-time benefits
• Flexible work-from-home schedule
• Opportunities for advancement and continued training
• Inclusive, bold company culture with strong values
✍️ Call to Action
Ready to help clean up healthcare from the inside out? Apply now to join Claritev as a Medical Investigator and be part of a team committed to making healthcare smarter, leaner, and more equitable.