Senior Medical Claims Specialist — High-Dollar Adjudication

Personify Health; Tempe (AZ); On-site; USD 30,000 - 34,000; Full time

Benefits offered by this job

Competitive base salary and benefits

Medical and dental coverage

Paid Time Off

Mental health support

Retirement planning

Professional development

Diversity and inclusion culture

Job summary

Personify Health in Tempe, AZ is seeking a claims adjudication specialist to review and process high-dollar, dialysis, and stop loss claims with precision and compliance.

You will enforce quality standards, stay current on regulatory guidelines, manage plan setup, renewals, and vendor communications to keep claims accurate and on time. This role requires 4+ years in healthcare claims, knowledge of ICD-9, CPT, HCPCS, and experience navigating multiple claims systems.

Qualifications

• Knowledge of medical terminology and coding (ICD-9, CPT, HCPCS).
• 4+ years in claims processing, adjudication, or related healthcare operations.
• Experience working across multiple claims processing systems.

Responsibilities

• Adjudicate high-dollar and specialty claims: review, analyze, and process complex healthcare, dialysis, and stop loss claims with precision.
• Enforce quality and procedural standards: ensure claims are handled per policy and procedure.
• Stay current on regulatory and industry standards: track evolving claims processing guidelines and requirements.
• Hit production and timeliness targets: complete work within required timeframes.
• Resolve escalations for the claims team: provide expertise for complex issues.
• Validate plan setup and documentation: review plans and vendor information for proper configuration.
• Manage the stop loss renewal process: oversee renewal-related claims work.
• Complete required training on schedule: stay up to date with training and compliance.
• Drive follow-through on open items: close outstanding tasks and inquiries.
• Support client and vendor relationships: serve as a point of contact for clients and vendors.

Skills

Medical terminology (ICD-9/CPT/HCPCS)

Claims processing expertise

Microsoft Office proficiency

Education

Bachelor's degree in Business/Healthcare Administration or related field

Tools

Claims processing systems

Reporting tools

Job description

Personify Health in Tempe, AZ is seeking a claims adjudication specialist to review and process high-dollar, dialysis, and stop loss claims with precision and compliance.

You will enforce quality standards, stay current on regulatory guidelines, manage plan setup, renewals, and vendor communications to keep claims accurate and on time. This role requires 4+ years in healthcare claims, knowledge of ICD-9, CPT, HCPCS, and experience navigating multiple claims systems.