Claims Specialist (Health Insurance)

Location: Remote Flex - North Carolina; remote work with a few in-office visits each year. Candidates may be considered from states listed on the posting, with onsite expectations discussed during the interview process.

Salary: $41,600.00–$66,561.00 per year

Company

hirify.global provides health insurance and works to improve health care delivery for the communities it serves.

What you will do

• Review, process, adjust, and update moderate to complex claims payments and payment errors.
• Manage daily work queues, claim quality, turnaround times, compliance requirements, and final resolutions.
• Respond to inquiries from customer service professionals, subscribers, providers, physicians, and other insurance carriers.
• Resolve suspended claims by reviewing eligibility, claims history, benefits, and related information.
• Escalate specialized claims, investigate potential fraud and abuse, and coordinate with the Special Investigations Unit.
• Identify system issues, recommend solutions, support process improvements, and represent Claims on project teams.

Requirements

• High school diploma or GED.
• 3+ years of experience in a related field.
• Experience managing claims quality, performance standards, and compliance requirements.
• Employment authorization sponsorship is not available for this position.

Nice to have

• Experience in health insurance claims operations.

Culture & Benefits

• Remote Flex work model with flexibility and intentional in-person connection.
• Medical, dental, and vision coverage with health and wellness programs.
• Parental leave, adoption assistance, and surrogacy assistance.
• Career development programs and tuition reimbursement.
• Paid time off and a 401(k) match with an annual company contribution.