Senior Health Claims Strategist

Personify Health, Inc.; Tempe (AZ); Hybrid; USD 30.000 - 34.000; Vollzeit

Benefits dieser Stelle

Medical & dental benefits

Paid time off

Mental health support

Retirement planning

Career development

Mission-driven culture

Zusammenfassung

Personify Health in Tempe, AZ seeks an experienced claims professional to adjudicate high-dollar and specialty claims, ensuring compliance and accurate processing across multiple systems. You will enforce quality standards, stay current with regulations, and meet production timelines to protect client interests and financial health.

The role requires 4+ years in claims processing, healthcare operations, and cross-system experience, with strong medical terminology knowledge and proficiency in MS

Qualifikationen

• Degree in Business, Healthcare Administration, or 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

Aufgaben

• Adjudicate high-dollar and specialty claims with scrutiny
• Enforce quality and procedural standards per policy
• Stay current on regulatory and industry standards for compliance
• Hit production and timeliness targets within required timeframes
• Resolve escalations for complex claim issues
• Validate plan setup and vendor documentation and flag errors
• Manage the stop loss renewal process as directed
• Complete required training on schedule
• Drive follow-through on open items and inquiries
• Support client and vendor relationships to keep claims moving

Kenntnisse

Claims processing

Multi-system experience

Medical terminology

MS Office & reporting

Ausbildung

Business/Healthcare degree or related

Tools

Claims processing systems

Microsoft Office Suite

Reporting tools

Jobbeschreibung

Personify Health in Tempe, AZ seeks an experienced claims professional to adjudicate high-dollar and specialty claims, ensuring compliance and accurate processing across multiple systems. You will enforce quality standards, stay current with regulations, and meet production timelines to protect client interests and financial health.

The role requires 4+ years in claims processing, healthcare operations, and cross-system experience, with strong medical terminology knowledge and proficiency in MS