Clinical Operations Spec (Health Insurance)

Location: Remote within the United States; employees are not hired from U.S. territories or Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, or Maine. The role requires a dedicated home office with approved high-speed wired internet.

Salary: $48,771–$61,698 USD target hiring range; maximum salary of $68,749 USD.

Company

hirify.global is a nonprofit member association providing health and dental benefits to federal employees, retirees, military retirees, and their families.

What you will do

• Perform administrative workflow tasks supporting Clinical Operations.
• Engage members, providers, and vendors to collect and communicate clinical and benefits information.
• Coordinate, review, and investigate claims to assess medical necessity and appropriateness of care.
• Identify cases for clinical programs, care management, and cost management.
• Interpret medical review results, recommend benefit allowances, and process contractual benefits.
• Escalate complex cases and report compliance, clinical, quality, and regulatory concerns.

Requirements

• Two years or 60 credit hours of college, or two years of healthcare experience; qualifying work experience may substitute for formal education.
• Intermediate proficiency with technology applications and systems.
• Experience with Microsoft Outlook, Excel, Word, and Teams.
• Effective written and verbal communication skills.
• Home office with non-cellular high-speed internet is required; minimum speed is 30 Mbps download and 5 Mbps upload, with latency below 80 ms.
• Hotspots, satellite, and wireless internet are not permitted, and the workspace must protect member PHI and HIPAA information.

Culture & Benefits

• Competitive pay and an incentive plan.
• Health, vision, and dental benefits effective on the first day.
• 401(k) plan with dollar-for-dollar matching up to a 4% employee contribution plus a 6% annual company contribution.
• Paid time off, personal community enrichment time, and employee well-being programs.
• Company-provided life and disability insurance.
• Tuition assistance.