Senior Analyst, Payment Integrity Disputes (Healthcare Claims)

Location: Fully remote for candidates residing in Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; or Salt Lake City, Utah. The work model may adapt over time and could potentially include hybrid presence at an associated hub office.

Salary: $64,832–$85,092 per year, plus annual performance bonuses.

Company

hirify.global is a health insurance company built around a full-stack technology platform focused on serving its members.

What you will do

• Support payment integrity disputes, appeals, issue resolution, and internal claims processing edits.
• Investigate disputes and adverse claim outcomes using claims infrastructure, workflows, platform logic, data models, and workflow tooling.
• Research industry-standard coding rules and contribute to reimbursement policy language and scope.
• Identify payment integrity opportunities through claims review, data mining, partner submissions, and process monitoring.
• Translate findings into business requirements and collaborate with internal partners to implement solutions and workflow improvements.
• Provide root cause analysis, research, training, status updates, and issue resolution support for escalated matters.

Requirements

• Experience in payment integrity focused on disputes and/or appeals.
• At least 4 years of experience in claims processing, coding, auditing, or healthcare operations.
• At least 3 years of experience in medical coding and a medical coding certification through AAPC or AHIMA, such as CPC, COC, CCS, RHIT, or RHIA.
• Experience with reimbursement methodologies, provider contract concepts, and claims processing and resolution practices.
• At least 2 years of experience deriving business insights from datasets and solving problems.
• At least 1 year of experience improving business workflows and collaborating with internal and external stakeholders.

Nice to have

• Technical or process improvement experience, including QA analysis, operations analysis, finance, consulting, industrial engineering, Six Sigma, or similar.
• Experience working with large datasets using Excel or a database language, including SQL.
• Experience in a professional healthcare claims organization.
• Knowledge management, training, or operational content development experience.
• Process improvement or Lean Six Sigma training.

Culture & Benefits

• Full-time employment with medical, dental, and vision benefits.
• Unlimited vacation program, paid sick time, 11 paid holidays, and paid parental leave.
• 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
• Collaborative environment focused on transparency, belonging, and support.