[Hiring] Claims Specialist REMOTE USA
Position: Claims Specialist
Date Posted: December 16, 2025
Industry: Healthcare / Insurance
Employment Type: Full Time
Experience: Minimum 2 years’ experience in healthcare claims examination or adjudication
Qualification: High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred
Salary: $20 – $24 per hour
Location: United States, REMOTE
Company: Personify Health
Description:
Personify Health is seeking a dedicated Claims Specialist to join our team and help simplify and personalize the healthcare experience for our clients. This role is responsible for reviewing, analyzing, and processing healthcare claims to ensure accuracy, completeness, and compliance with company policies and regulatory standards. The ideal candidate will have strong knowledge of health insurance guidelines and experience across multiple claims processing systems.
Key Responsibilities:
- Maintain quality and procedure standards, including complete review and examination of claims to ensure proper handling according to company policies
- Complete claims tasks in a timely manner while meeting production requirements
- Review and understand plans, documents, and vendor details; ensure proper system setup during claims processing
- Identify and report potential errors or issues related to plan documents, claims processing, or system setup
- Support stop-loss renewal processes as directed by management
- Complete all training requirements promptly and comply with company procedures and standards
- Ensure follow-up procedures are conducted to complete tasks and respond to inquiries
- Provide direct client contact and vendor support to ensure customer and member satisfaction
- Assist management with projects and special requests
Qualifications:
- Strong knowledge of medical terminology, CPT/ICD-10 coding, and healthcare billing procedures
- Experience with multiple claims processing platforms preferred
- Prior experience with both manual and automated claims processing
- Excellent communication, analytical, and problem-solving skills
- Ability to work collaboratively with diverse teams
Benefits and Perks:
- Comprehensive medical insurance
- Flexible work arrangements
- Retirement planning support
- Life and AD&D insurance, short-term and long-term disability coverage
- Professional development opportunities and mentorship programs
- Unlimited PTO policy and supportive work culture
Personify Health values diversity, equity, inclusion, and belonging (DEIB) and is committed to creating an inclusive environment where all employees can thrive.
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