Claims Representative (Insurance)

Location: Remote Flex in North Carolina, with eligibility for candidates in states listed on the posting; occasional in-office visits may be required.

Salary: $41,600–$66,561 per year, plus an annual incentive bonus.

Company

hirify.global provides health insurance and healthcare-related services with a focus on community health and member support.

What you will do

• Review, adjudicate, adjust, and update routine medical claims and payment errors.
• Manage daily work queues while maintaining claims quality, accuracy, and turnaround-time requirements.
• Respond to inquiries from subscribers, providers, physicians, internal service teams, and other insurance carriers.
• Resolve suspended claims by reviewing benefit eligibility, claims history, and related information.
• Identify system issues, document problems, recommend solutions, and coordinate follow-up with technical staff.
• Coordinate payment liability with other insurers and Medicare and escalate suspected fraud and abuse for investigation.

Requirements

• High school diploma or GED.
• 0–2 years of experience in a related field.
• Ability to process and analyze medical insurance claims accurately.
• Ability to meet established quality, compliance, and performance standards.
• Ability to work remotely from an eligible US state and attend occasional in-office visits.

Nice to have

• Data entry experience.

Culture & Benefits

• Remote Flex work with virtual work and a few in-office visits each year.
• Medical, dental, and vision coverage with health and wellness programs.
• Parental leave, adoption assistance, and surrogacy assistance.
• Career development programs and tuition reimbursement.
• 401(k) match with an annual company contribution, paid time off, and work-life balance support.