Claims Processor IV (Healthcare)

Location: Telecommuter; hiring is limited to listed U.S. states, including 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: $48,400–$72,600 national range; $55,200–$82,800 national plus range per year.

Company

hirify.global works to improve healthcare outcomes and customer experiences through health insurance services.

What you will do

• Review, research, process, and resolve moderate to highly complex medical and dental claims.
• Reprocess carve-out and high-dollar claims, including transplant, hospital, benefit exchange, SCCA, and BDCT claims.
• Perform accumulator adjustments, deductible credit loads, member history reviews, and follow-up on pending claims.
• Coordinate with Configuration, Customer Service, Marketing Liaisons, Appeals, Care Facilitation, and other claims teams.
• Identify procedural changes, update documentation, and complete specialized audits and process-improvement projects.
• Serve as a subject matter expert by training, auditing, and coaching other claims processors while meeting productivity and quality goals.

Requirements

• High school diploma or GED required.
• At least two years of claims processing experience in medical or dental plans, or two years of medical, dental, or insurance industry experience.
• Ability to interpret policies and contracts, research claim histories, and document reprocessing decisions accurately.
• Ability to keyboard, communicate clearly by telephone and in person, maintain confidentiality, and perform sedentary work.

Nice to have

• Detailed knowledge of Premera processing systems.
• Experience auditing other processors.
• Understanding of out-of-area programs.

Culture & Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Life and disability insurance, a 401(k) employer match, and a pension vested after three years.
• Paid time off, wellness and mental well-being resources, counseling, and mindfulness programs.
• Tuition assistance for undergraduate and graduate education.
• Employee recognition programs and opportunities for professional development.