Senior Claims Configuration Auditor: Quality & Compliance

Personify Health; Tempe (AZ); Hybrid; USD 70,000 - 83,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Paid time off

Mental health support

Retirement planning

Professional development

Job summary

Personify Health is seeking a claims configuration and audit specialist to ensure accurate setup of client plans and contracts. You will lead end-to-end audits, translate SPDs into system rules, and validate changes before production to prevent errors and ensure regulatory compliance.

You will analyze complex claims, identify root causes, and propose fixes to improve auto-adjudication rates while supporting cross-functional system updates and quality controls.

Qualifications

• 3+ years in claims configuration, auditing, quality assurance, or related healthcare operations.
• Experience in self-funded health plans or TPA environments preferred.
• Bachelor's degree or equivalent combination of education and experience.

Responsibilities

• Lead end-to-end audits of complex claims configurations against client requirements and contracts.
• Translate SPDs and plan language into precise system rules and cost-sharing structures.
• Validate configuration changes before go-live and ensure compliance with regulatory guidelines.
• Analyze claims for accuracy and troubleshoot adjudication and processing outcomes.

Skills

Attention to detail

Excellent communication

Problem-solving

Cross-functional collaboration

Education

Bachelor's degree in Healthcare Administration / Business / Information Systems

Equivalent combination of education and experience

Tools

Javelina claims processing platform

Core claims systems

Job description

Personify Health is seeking a claims configuration and audit specialist to ensure accurate setup of client plans and contracts. You will lead end-to-end audits, translate SPDs into system rules, and validate changes before production to prevent errors and ensure regulatory compliance.

You will analyze complex claims, identify root causes, and propose fixes to improve auto-adjudication rates while supporting cross-functional system updates and quality controls.