Claims Processor III

Location: Telecommuter; hiring is limited to Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, and Wisconsin

Salary: $44,800–$67,200 national range; $51,000–$76,500 national plus range

Company

hirify.global is a healthcare organization focused on improving how healthcare works for customers and members.

What you will do

• Review, research, and resolve moderate to complex claims according to contracts, policies, and reference materials.
• Investigate coordination-of-benefits, subrogation, general inquiry, Medicare, DSHS, large-dollar medical, and claim reprocessing issues.
• Complete claim adjustments, reversals, refunds, formal history reviews, and follow-up on pended claims.
• Serve as a technical subject matter expert by auditing trainee claims, providing feedback, and supporting team training.
• Communicate claim outcomes through written correspondence and inbound and outbound calls.
• Meet productivity and cycle-time goals while maintaining confidentiality and quality standards.

Requirements

• High school diploma or GED.
• At least one year of claims processing or customer service experience.
• Understanding of out-of-area programs.
• In-team-focused audit experience.
• Ability to keyboard and communicate clearly by telephone and in person.
• Ability to perform primarily sedentary work and occasionally handle up to 10 pounds, with or without accommodation.

Culture & Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Life and disability insurance, retirement programs with a 401(k) employer match, and a pension vested after three years.
• Generous paid time off, wellness resources, counseling, stress management, and mindfulness programs.
• Tuition assistance for undergraduate and graduate degrees.
• Employee recognition programs and opportunities for collaboration and professional development.