Senior High-Value Claims Specialist

Personify Health, Inc.; United States; Remote; USD 30,000 - 34,000; Full time

Benefits offered by this job

Competitive base salary + benefits day

Comprehensive medical and dental

Paid Time Off

Mental health support

Professional development

Mission-driven culture

Job summary

Personify Health, Inc. in the United States is seeking a claims adjudication specialist to review and process high-dollar and specialty claims, ensuring accuracy and regulatory compliance across intake to resolution.

You will own production targets, guide escalations, verify plan setup, and support the stop-loss renewal process. The role requires 4+ years in claims processing and a healthcare background, with competitive pay and benefits.

Qualifications

• Degree in Business, Healthcare Administration, or related field (or equivalent work experience).
• 4+ years in claims processing or adjudication in healthcare/insurance.
• 4+ years across multiple claims processing systems.
• Healthcare industry background preferred (health insurance, billing, clinical ops).

Responsibilities

• Adjudicate high-dollar and specialty claims through intake to resolution.
• Enforce quality and compliance standards on each claim.
• Meet production and turnaround targets while maintaining accuracy.
• Guide the claims team on escalations with complex questions.
• Verify plan setup and documentation before processing.
• Flag potential errors at the source to prevent issues.
• Support stop loss renewal tasks on schedule.
• Stay updated on regulatory guidelines and training.
• Provide direct client and vendor support to resolve questions.
• Assist with strategic projects to strengthen claims operations.

Skills

Medical terminology

ICD-9 CPT HCPCS coding

Claims processing systems

Reporting tools

Insurance databases

Education

Degree in Business or Healthcare Administration

Tools

Microsoft Office Suite

Job description

Personify Health, Inc. in the United States is seeking a claims adjudication specialist to review and process high-dollar and specialty claims, ensuring accuracy and regulatory compliance across intake to resolution.

You will own production targets, guide escalations, verify plan setup, and support the stop-loss renewal process. The role requires 4+ years in claims processing and a healthcare background, with competitive pay and benefits.