Claims Processor II

Location: Telecommuter; hiring is limited to specified U.S. states

Salary: $41,500–$62,300 national range; $47,400–$71,100 national plus range for higher-cost labor markets, including Western Washington and Alaska.

Company

hirify.global works to improve healthcare for its members, customers, and communities.

What you will do

• Review, research, process, and resolve moderately complex dental, medical, and hospital claims.
• Interpret contracts, policies, procedures, and benefits to ensure accurate claims adjudication.
• Code claims, translate data for the processing system, and follow up on pending claims.
• Prepare claims for return to providers or subscribers when additional information is required.
• Complete adjustments, reversals, refunds, and coordination with other carriers or provider offices as needed.
• Maintain confidential claims files and may train and provide feedback to new associates.

Requirements

• High school diploma or GED required.
• At least six months of claims processing or customer service experience required.
• Ability to understand claims processing steps, contract benefits, and correction procedures.
• Ability to meet accuracy, productivity, and cycle-time goals.
• Ability to keyboard and communicate clearly by telephone and in person.
• Applicants must be located in one of the states where Premera is hiring for this role.

Nice to have

• Experience with an out-of-area program.
• Technical experience with contract benefits, claims processing, and correction procedures.

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 plan vested after three years.
• Paid time off, wellness resources, counseling, stress management, and mindfulness programs.
• Tuition assistance for undergraduate and graduate education.
• Employee recognition programs and opportunities for professional development.