Operations Associate, Payment Integrity (Healthcare)

TL;DR

Operations Associate, Payment Integrity (Healthcare): Managing claims reprocessing and recovery workflows for a health insurance platform with an accent on data validation, financial reconciliation, and audit optimization. Focus on ensuring accurate medical claim payments, reducing audit inventory lag, and optimizing end-to-end recovery processes.

Location: Remote (USA)

Salary: $63,000 - $83,000 USD

Company

hirify.global is a health insurance company leveraging data and technology to provide high-quality, affordable healthcare plans for seniors.

What you will do

• Execute high-volume claim reprocessing cycles using advanced data management and spreadsheeting techniques.
• Perform backend controls and comprehensive reconciliations to audit the accuracy of reprocessed claims.
• Manage recovery posting and oversee the audit software environment to track resolutions and recognize recoveries.
• Administer end-to-end audit communications, including data extraction, SFTP transfers, and file uploads.
• Maintain audit software integrity by researching and resolving aging audits to minimize inventory lag.
• Collaborate with Claims Adjustment and Provider Services to resolve escalated payment issues and optimize outcomes.

Requirements

• 3+ years of experience working with large datasets, reconciliations, and data validation in high-volume environments.
• Must be based in the USA.
• Strong proficiency in Excel or Google Sheets, specifically with pivots and lookups for processing extensive data.
• Experience supporting financial audits within a healthcare setting, with exposure to claims data or payments.
• Technical savviness and the ability to learn new systems and workflows quickly.

Nice to have

• Experience with SQL.
• Familiarity with healthcare audit or analytics tools.

Culture & Benefits

• Comprehensive medical, dental, and vision coverage for employees and families.
• Financial perks including 401k matching, performance-based bonuses, and an Employee Stock Purchase Plan (ESPP).
• Mental well-being support through No-Meeting Fridays, monthly company holidays, and flexible time-off.
• Remote-first culture with reimbursement for office setup and monthly cell phone & internet stipends.
• Professional development via learning programs, mentorship, and dedicated funding.