Member Claim Processing Senior Associate (Healthcare)

Location: Remote USA

Salary: $58,000–$82,000 annually

Company

hirify.global is a healthcare company founded in 2017 that combines an integrated care platform, advanced data and AI, and clinical and service experiences to improve the health and well-being of older Americans.

What you will do

• Own the day-to-day operational execution of member claim processing for the Medicare Advantage business.
• Process complex, escalated, and non-standard claims that fall outside routine adjudication.
• Monitor claim inventory, aging, turnaround times, and service-level requirements, escalating compliance risks and clearing bottlenecks.
• Follow standard operating procedures and escalate scenarios requiring clarification to ensure accurate processing.
• Partner with Claims Operations, Configuration, and Technology leadership to identify root causes of processing errors and rework.
• Support member claim appeals and member claim cases.

Requirements

• Strong organization skills, attention to detail, and the ability to document important information.
• Ability to process claims accurately and efficiently in an operations-focused environment.
• Strong communication and writing skills, including the ability to explain complex concepts clearly and craft accurate, plain-language member communications.
• Experience building and maintaining clear, repeatable process documentation that can withstand audits.
• Bachelor’s degree or equivalent work experience.

Nice to have

• Experience in healthcare, healthcare technology, or technology operations.
• Experience with Medicare Advantage claims adjudication, member reimbursement, or CMS timeliness requirements.
• Experience thriving in a fast-paced startup environment and working with high throughput.
• Experience becoming proficient with unfamiliar tools or systems.
• Experience with data, analytics, and business intelligence platforms such as Snowflake or Looker.

Culture & Benefits

• Remote work for a USA-based role.
• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off and a parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options for all employees and bonus eligibility for roles below Director level.
• 401(k) program and a collaborative, supportive work environment.