Claims Examiner II

Location: Remote, United States

Company

hirify.global provides AI-powered operational infrastructure that helps health insurance companies modernize claims and healthcare operations.

What you will do

• Process assigned healthcare claims according to client-specific guidelines and team-lead direction.
• Review claims data, system edits, medical services, and benefit coverage criteria to determine payment outcomes.
• Meet productivity, financial accuracy, and procedural quality standards.
• Mentor junior team members and collaborate on special projects.
• Support process documentation, training, quality audits, provider data, authorizations, enrollment, and surge activity.
• Communicate issues and concerns to management and take preventive measures to maintain processing accuracy.

Requirements

• High school diploma or equivalent.
• 1–3 years of healthcare claims processing experience.
• Ability to analyse claim data and apply healthcare policies and procedures.
• Knowledge of physician and hospital coding, billing, medical terminology, CPT, HCPCS, ICD-10, UB-04, CMS-1500, and authorizations.
• Ability to adapt quickly, learn new skills, collaborate effectively, and maintain a strong work ethic.
• Must be available for a remote role based in the United States.

Culture & Benefits

• Full-time, permanent employment.
• Work in a hybrid or remote environment across multiple time zones.
• Long periods of computer-based work using video technology.
• Occasional travel may be required based on company needs.
• Reasonable accommodations are available in compliance with the Americans with Disabilities Act.