Now is the time to join us! 

Who are you?

In this role, your will support the insurance claim and reimbursement process. This is an amazing opportunity to learn more about the health care industry and advance your career with a rapidly expanding organization!

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

• Prepare Stop Loss claims and applicable documents to determine stop loss filing eligibility applicable to the excess loss policy
• Files submissions of spec claimants (running reports, gathering necessary documents and email correspondence), processing all submissions within established internal timeframes
• Coordinate advanced funding requests, with the client and their stop loss carrier
• Creates initial specific file for each claimant and files all submissions in our EDOCS platform
• Coordinates the release of “on hold” claims
• Acts as the liaison between the PBM’s and internal clients, as it pertains to our stop Loss claimants
• Keeps immediate supervisor apprised of open or disputed items
• Contributes to daily workflow with regular and punctual attendance
• Generates weekly outstanding reimbursement report and follows up with the Stop Loss carrier

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 general education degree (GED) required.
• Experience processing stop loss and/or health insurance claims
• Knowledge of medical terminology, CPT, HCPCS and ICD-10 codes
• Strong written and verbal communication skills
• Proficient in Word, Excel, and outlook
• Ability to organize, prioritize, and multitask in a fast-paced environment
• Demonstrate ability to work independently with excellent judgment
• A detail-oriented, analytical, financially minded approach

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

• Must be computer literate and knowledgeable in Windows and Microsoft Office environment, including Word, Excel and Outlook.
• Knowledge of insurance database system a plus.
• Ability to read, analyze, and interpret common financial reports and legal documents.
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
• Ability to effectively present information to top management, public groups, and/or boards of directors.
• Ability to work with mathematical concepts such as probability and statistical inference.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

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 up to $22.00 per hour. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

#LI-REMOTE