Senior Medical Claims Specialist (Healthcare)

Location: Tempe, Arizona; candidates must be able to commute to this location weekly

Salary: $22–$25 per hour, depending on location, skills, and experience

Company

hirify.global provides a personalized health platform combining health plan administration, wellbeing solutions, and care navigation for employers, health plans, and health systems.

What you will do

• Review, analyze, and adjudicate high-dollar, healthcare, dialysis, and stop loss claims.
• Conduct claim reviews to ensure compliance with company policies, procedures, and regulatory requirements.
• Complete claims work within production and timeliness standards.
• Resolve escalated claim questions and complex issues for the claims team.
• Validate plan setup, documentation, vendor information, and system configuration.
• Manage stop loss renewal claims work and support clients, internal teams, and vendors.

Requirements

• 4+ years of experience in claims processing, adjudication, or healthcare and insurance operations.
• 4+ years of experience working with multiple claims processing systems.
• Knowledge of medical terminology, including ICD-9, CPT, and HCPCS coding.
• Proficiency with claims processing systems, Microsoft Office Suite, and reporting tools.
• Healthcare industry experience in health insurance, medical offices, billing, admissions, or clinical front-desk operations is strongly preferred.
• A degree in Business, Healthcare Administration, or a related field is preferred; equivalent experience is considered.

Culture & Benefits

• Full benefits package begins on the first day of employment.
• Medical and dental coverage is provided through hirify.global solutions.
• Paid time off, mental health support, retirement planning, and financial protection are available.
• Professional development includes career progression and learning budgets.
• Work in a mission-driven environment focused on improving health outcomes and valuing diverse perspectives.