Claims Processor IV

Location: Telecommuter; hiring is available in Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, and Wisconsin, with some limitations based on role or city.

Salary: $48,400–$72,600 national range; $55,200–$82,800 national plus range for higher-cost labor markets, including Western Washington and Alaska.

Company

hirify.global provides healthcare insurance and services focused on improving members’ lives and making healthcare work better.

What you will do

• Review, research, enter, and resolve moderate to highly complex medical and dental claims.
• Reprocess carve-out, organ transplant, SCCA, BDCT, benefit exchange, and high-dollar hospital claims using contractual agreements and claims history.
• Complete accumulator adjustments, deductible credit loads, member history reviews, claim notes, routing, refund requests, and configuration documentation.
• Communicate with Configuration, Customer Service, Marketing Liaisons, Care Facilitation, Appeals, and other claims teams.
• Identify procedural changes, update processes, complete specialized audits, and provide training, feedback, and coaching.
• Meet cycle-time and productivity goals while maintaining claims accuracy and confidentiality.

Requirements

• High school diploma or GED.
• At least two years of claims processing experience in medical or dental plans, or two years of medical, dental, office, or insurance industry experience.
• Detailed knowledge of Premera claims processing systems.
• Ability to audit other processors and provide specialized knowledge of complex claims processing.
• Understanding of out-of-area programs and experience in another Premera functional area, such as M&B, CSR, PIMS, PS&S, or Sales.
• Must be eligible to work from one of the listed U.S. states.

Culture & Benefits

• Medical, vision, and dental coverage with low employee premiums.
• 401(k) employer match, pension plan vested after three years, life and disability insurance.
• Generous paid time off, wellness resources, counseling, stress management, and mindfulness programs.
• Tuition assistance for undergraduate and graduate degrees.
• Employee recognition programs and support for professional development.