Claims Processor (Healthcare)

Location: Working from home in Pennsylvania, United States

Company

hirify.global provides health insurance services and processes member and provider claims.

What you will do

• Receive, enter, and verify claims data for completeness and accuracy.
• Resolve claim edits, review claim history, and determine benefit eligibility.
• Review payment levels and make final payment determinations.
• Research and finalize claims, adjustments, inquiries, and reports.
• Escalate issues when appropriate and maintain professional communication with internal and external customers.
• Meet production and quality standards, maintain accurate records, and complete required training.

Requirements

• High school diploma or GED.
• At least 1 year of related experience; claims processing experience is preferred.
• Strong verbal and written communication skills.
• Ability to navigate multiple systems, review critical data, solve problems within established guidelines, and use mathematics to adjudicate claims.
• Knowledge of administrative and clerical procedures, records management, and claim-processing operating systems.
• Must work from Pennsylvania, United States.

Nice to have

• Experience with inquiry resolution systems, OCWA, Oscar, and Outlook.

Culture & Benefits

• Home-based work arrangement in Pennsylvania.
• Travel requirement of 0%–25%.
• Work involves protecting confidential customer information and complying with HIPAA, privacy, security, and business-conduct requirements.
• Physical work site requirements include lifting up to 10 pounds constantly and 10–25 pounds occasionally.