Claims Specialist (Health Insurance)

Location: Remote Flex - North Carolina; virtual work with a few in-office visits each year. The role is available in listed US states, with onsite expectations discussed during the interview process.

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

Company

hirify.global provides health insurance and healthcare services focused on improving care and supporting communities.

What you will do

• Process, adjust, update, and adjudicate moderate to complex claims and payment errors.
• Review benefit eligibility, claims history, and related information to resolve suspended claims.
• Respond to inquiries from customers, providers, physicians, customer service professionals, and other insurance carriers.
• Monitor claims quality, turnaround times, compliance requirements, and performance standards.
• Escalate specialized cases, investigate potential fraud and abuse, and coordinate with Special Investigations, Provider Services, other carriers, and Medicare.
• Document system issues, recommend solutions, contribute to process improvements, and represent Claims on project teams.

Requirements

• High school diploma or GED.
• 3+ years of experience in a related field.
• Ability to manage daily work queues and resolve non-routine claims across business segments and provider types.
• Employment authorization sponsorship is not available for this position.

Nice to have

• Health insurance claims experience.
• Facets claims experience.

Culture & Benefits

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