Senior High Risk Claims Specialist

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $22 - $25 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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Personify Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2023

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Personify Health is the first personalized health platform company, designed to empower individuals and organizations to achieve better health outcomes through tailored solutions and services. They offer a comprehensive range of solutions including wellbeing navigation, care management, and health plan administration, catering to employers, health systems, health plans, and brokers. Their goal is to simplify healthcare experiences and enhance engagement, ultimately helping businesses optimize their investment in employee health and wellbeing.

📋 Description

• Review, analyze, and process complex healthcare, dialysis, and stop loss claims from intake through resolution • Examine claims against company policy and regulatory requirements • Complete claims work within required timeframes while maintaining accuracy • Serve as a go-to resource for complex questions and escalations • Review plan documents and vendor arrangements to validate system configuration • Identify and escalate potential errors in plan documents, claims processing, or system setup • Manage assigned stop loss renewal tasks accurately and on schedule • Complete required training and stay current on regulatory and industry standards • Support clients, internal staff, and vendors with claims questions • Resolve claims questions and keep cases moving • Take on special assignments that strengthen the broader claims operation

🎯 Requirements

• Degree in Business, Healthcare Administration, or a related field preferred; equivalent work experience considered • 4+ years of experience in claims processing, adjudication, or related healthcare/insurance operations • 4+ years of experience working across multiple claims processing systems • Healthcare industry background preferred, including health insurance, medical office, billing, or clinical operations experience • Thorough knowledge of medical terminology and ICD-9, CPT, and HCPCS coding • Proficiency with claims processing systems and Microsoft Office Suite • Experience with reporting tools • Working knowledge of insurance database systems a plus • Ability to complete required training and keep pace with evolving claims processing guidelines and industry standards

🏖️ Benefits

• Competitive base salary • Comprehensive medical and dental through our own health solutions • Paid Time Off • Mental health support • Retirement planning • Financial protection • Professional development with clear career progression and learning budgets • Wellness programs • Other employee perks • Full benefits package effective day one