Senior Health Claims Specialist — High-Dollar & Compliance

Personify Health; Tempe (AZ); On-site; USD 46,000 - 52,000; Full time

Benefits offered by this job

Competitive salary

Medical & dental

Paid time off

Mental health support

Retirement planning

Career development

Inclusive culture

Job summary

Personify Health is seeking a claims processor in Tempe, AZ to adjudicate high-dollar and specialty claims with precision and regulatory compliance. You will review complex healthcare, dialysis, and stop loss claims, ensuring accuracy and adherence to policy.

This role requires commuting to Tempe weekly and delivering timely, quality results within a collaborative team. Experience in claims processing, multi-system navigation, and healthcare operations is essential.

Qualifications

• Degree in Business, Healthcare Administration, or a related field preferred; equivalent 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 strongly preferred, including experience in health insurance, medical office, billing, admissions, or clinical front-desk settings

Responsibilities

• Adjudicate and process high-dollar and specialty claims.
• Ensure compliance with company policies and procedures.
• Stay current with regulatory and industry standards.
• Meet production and timeliness targets.
• Handle escalations and provide expert guidance.
• Review plans and vendor documentation for accuracy.
• Support renewal processes for stop loss.
• Complete required training on schedule.
• Track open items to drive closure.
• Maintain client and vendor relationships to keep claims moving.

Skills

Medical terminology

ICD/CPT/HCPCS

Claims processing

Regulatory compliance

Education

Bachelor's degree or equivalent experience

Tools

Claims processing systems

Microsoft Office

Reporting tools

Insurance databases

Job description

Personify Health is seeking a claims processor in Tempe, AZ to adjudicate high-dollar and specialty claims with precision and regulatory compliance. You will review complex healthcare, dialysis, and stop loss claims, ensuring accuracy and adherence to policy.

This role requires commuting to Tempe weekly and delivering timely, quality results within a collaborative team. Experience in claims processing, multi-system navigation, and healthcare operations is essential.