Senior Claims Specialist (Healthcare)

Location: Tempe, AZ; candidates must be able to commute to the location weekly

Salary: $22–$25 per hour, depending on location, skills, and experience

Company

hirify.global provides a personalized health platform combining health plan administration, wellbeing solutions, and care navigation for employers, health plans, and health systems.

What you will do

• Review, analyze, and adjudicate high-dollar, specialty, healthcare, dialysis, and stop loss claims.
• Conduct claim reviews to ensure compliance with company policies, procedures, and regulatory requirements.
• Process claims within required production and timeliness targets.
• Resolve escalated claim questions and complex issues for the claims team.
• Validate plan setup, documentation, vendor information, and system configuration, escalating errors when needed.
• Manage stop loss renewal claims work and follow open tasks and inquiries through resolution while supporting clients and vendors.

Requirements

• 4+ years of experience in claims processing, adjudication, or related healthcare or insurance operations.
• 4+ years of experience working across multiple claims processing systems.
• Thorough knowledge of medical terminology, including ICD-9, CPT, and HCPCS coding.
• Proficiency with claims processing systems, Microsoft Office Suite, and reporting tools.
• Healthcare industry experience in health insurance, medical office, billing, admissions, or clinical front-desk settings is strongly preferred.
• A degree in Business, Healthcare Administration, or a related field is preferred; equivalent experience may be considered.

Culture & Benefits

• Full benefits package effective from day one.
• Medical and dental coverage through hirify.global solutions.
• Paid time off, mental health support, retirement planning, and financial protection.
• Professional development, career progression, and learning budgets.
• Mission-driven environment focused on improving health outcomes and valuing diverse perspectives.