Who We Are

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

What makes this role different

The Claims Escalation Specialist is responsible for reviewing, analyzing, and processing healthcare claims, adjustments, and escalations to ensure accuracy, completeness, and compliance with policies and regulatory standards. They will have a strong understanding of health insurance guidelines and demonstrated experience working across multiple claims processing systems.

What You'll Actually Do

• Maintain quality and procedure standards including complete review and examination of claim situations to ensure proper handling in accordance with company policies and procedures.
• Complete claims task in timely manner and maintain production requirements.
• Review and understand plans, documents and vendors. Ensure proper system setup while processing claims. Identify and report to management any potential errors, problems or issues regarding plan documents, claims processing or system setup.
• Manage, resolve and respond to customer-initiated claim escalations, inquiries, or questions while ensuring high customer and/or client satisfaction.
• Perform root cause analysis, identify trends, and work with internal partners to rectify issues and make recommendations for service or process improvements.
• Work stop loss renewal process, as directed by management.
• Complete all training requirements in a timely manner, as directed by management.
• Understand and enforce company procedures, polices and standards.
• Practice good follow up procedures to ensure completion of task and/or inquiries.
• Direct client contact, internal staff and vendor support to ensure customer and member satisfaction.
• Support management team with projects and special requests.

What You Bring to Our Mission

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred.
• Minimum of 2 years’ experience in healthcare claims examination or adjudication.
• Strong knowledge of medical terminology, CPT/ICD-10 coding, and healthcare billing procedures.
• Expertise in multiple claims processing platforms, to include Anthem processing, a plus.
• Prior experience with both manual and automated claims processing.
• 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.

Why You'll Love It Here

We believe in total rewards that actually matter—not just competitive packages, but benefits that support how you want to live and work.

Your wellbeing comes first:

• Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
• Mental health support and wellness programs designed by experts who get it
• Flexible work arrangements that fit your life, not the other way around

Financial security that makes sense:

• Retirement planning support to help you build real wealth for the future
• Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
• Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage

Growth without limits:

• Professional development opportunities and clear career progression paths
• Mentorship from industry leaders who want to see you succeed
• Learning budget to invest in skills that matter to your future

A culture that energizes:

• People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
• One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
• We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
• Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable

The practical stuff:

• Competitive base salary that rewards your success
• Unlimited PTO policy because rest and recharge time is non-negotiable
• Benefits effective day one—because you shouldn’t have to wait to be taken care of

Ready to create a healthier world while building the career you want? We're ready for you.

No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this 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 $20.00 to $24.00 per hour. Note that compensation may vary based on location, skills, and experience. This position is part time and therefore not eligible for 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.