Now is the time to join us! 

Who are you?

As a Claims Specialist, you will complete claim processing tasks and duties while performing best practices in time management, inventory, quality and procedures.

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Processes medical and short-term disability claims while checking for duplicates, necessity and accuracy of codes, including refunds, voids and stop payments.
• Assure that all claims are processed for daily check runs.
• Pull daily claims over $5,000 for Claims Supervisor.
• Track all transplant cases or potential cases and assure information is passed to appropriate people.
• Prepares claims data and copies all related information for Stop Loss Claims submission to reinsurance carriers, including prescription drug claims.
• Works with eligibility to accumulate information required for Stop Loss claims submission.
• Completes 50% notices, Trigger diagnoses and submit to Stop Loss Carriers and Claims Supervisor.
• Answer incoming calls from group, providers and/or members as needed.
• Respond to emails and calls from group contacts and providers.
• Sort morning letters, copy, mail, file and attach copy to invoice.
• Review pending edit list and mail request letters.
• Reprice claims as necessary
• Retrieve repriced claims from internet, process and attach to claims
• Prepare check tracers and reissues for approval.
• Type out refund requests and note each claim
• Review plan documents for benefit determination.
• Assign benefits in accordance with Plan Document.
• Answer Customer Service questions, problems and help with benefit interpretation as needed.
• Assists other departments as needed and when time allows
• Various duties as may be assigned.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred.
• 2 years prior medical claims experience preferred.
• Strong knowledge of medical terminology, CPT/ICD-10 coding, and healthcare billing procedures.
• Prior experience with both manual and automated claims processing.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Excellent attention to detail and analytical skills.
• Effective verbal and written communication skills.
• Must be able to establish and maintain good working relationship with clients and provide excellent customer service.
• Must be computer literate and knowledgeable in Windows and Microsoft Office environment, including Word, Outlook and Excel.
• Ability to work with others to accomplish mutual goals.
• Healthcare industry experience is strongly preferred, specifically in healthcare, health insurance, or medical office billing.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $21.00 to $24.00 per hour. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: Open until position is filled.