Claims Specialist

Location: Remote; W2 employment only

Company

hirify.global provides staffing and contract employment opportunities.

What you will do

• Review, research, update, and recalculate benefits for previously processed medical claims.
• Process claims edits according to contractual benefits and provider-reimbursement rules.
• Determine the correct order of benefits for coordinated claims and update COB records.
• Investigate denials, adjusted claims, overpayments, system errors, and audit findings.
• Initiate refunds and recover overpaid funds from providers, subscribers, or beneficiaries.
• Support training, implementations, documentation, quality audits, and special projects.

Requirements

• High school diploma or equivalent.
• At least two years of medical claims-processing experience.
• Strong analytical, logical, systemic, investigative, communication, and human-relations skills.
• Working knowledge of relevant PC software and the ability to prioritize multiple workstreams.
• Must work on a W2 basis; C2C is not eligible.
• Visa sponsorship is available.

Nice to have

• Coordination-of-benefits processing experience, including determining primary and secondary coverage.
• Experience applying COB rules involving subscriber status, effective dates, plan type, and Medicare coordination.
• Experience communicating with members, providers, and insurers to verify coverage.
• Experience correcting overpayments, initiating refunds, and reprocessing claims.
• Experience with claims systems, HIPAA, regulatory requirements, and compliance procedures.

Culture & Benefits

• Remote contract opportunity.
• Five-month contract length.
• W2 employment arrangement.
• Visa sponsorship available.