Individual Market CIR Claims Processor III (Healthcare)

Location: Telecommuter; hiring is limited to 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.

Salary: $44,800–$67,200 national range; $51,000–$76,500 national plus range for higher-cost labor markets, including Western Washington and Alaska.

Company

hirify.global provides healthcare coverage and services focused on improving customers’ health and healthcare experience.

What you will do

• Review, research, and resolve moderate to complex dental, medical, and hospital claims using contracts, policies, reference materials, and online tools.
• Resolve coordination of benefits, subrogation, Medicare, DSHS, large-dollar medical, and claim reprocessing issues.
• Complete claim adjustments, reversals, refunds, formal history reviews, and follow-up on pended claims.
• Serve as a technical subject matter expert by training and auditing trainee claims and providing feedback and support.
• Communicate claim-resolution results with internal and external customers through written communication and inbound and outbound calls.
• Maintain confidentiality while meeting productivity, cycle-time, and first-time quality goals.

Requirements

• High school diploma or GED.
• At least one year of claims processing or customer service experience.
• Understanding of out-of-area programs.
• Experience with in-team-focused auditing.
• Ability to interpret procedures, policies, benefit rules, and reference materials accurately.

Culture & Benefits

• Full-time employment with medical, vision, and dental coverage.
• Life and disability insurance, a 401(k) employer match, and a pension vested after three years.
• Paid time off, wellness resources, counseling, and mindfulness programs.
• Tuition assistance for undergraduate and graduate degrees.
• Employee recognition programs and opportunities for professional development.