Processes healthcare claims by reviewing and verifying documents, entering claim and UB04 data, assigning statuses, routing files, preparing appeal letters, adjusting reimbursement information, and escalating issues. The role requires accurate data entry, document management, attention to detail, and compliance with HIPAA and security standards while collaborating with internal teams and clients.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
About the Opportunity
At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow.
The Claims Coordinator handles the accurate and timely processing of healthcare claims. This role reviews notifications, checks documents for completeness, sets up claims in the system, and routes them to the right departments. The coordinator escalates problem claims, communicates missing information, and follows HIPAA and security standards to support a smooth claims review process.
What you’ll do
- Monitor incoming claim notifications and ensure all required documents are complete and legible.
- Verifying all required submission documents are present and legible.
- Perform initial claim setup, accurately enter data, and assign correct claim statuses.
- Perform initial analysis of data and documents submitted by the client such as claims, EOBs, bills, policies, correspondence, etc.
- Combine and Extract claim documents when needed.
- Copy combined file and rename according to policy and procedures.
- Enter UB04 data information for analyst.
- Transfer claim documents to Document Management and IBR departments.
- Create appeal letters and return to client.
- Analyzes the client provided coversheet for correct reimbursement.
- Adjust system to reflect the correct reimbursement and savings.
- Escalate claims with problems to Lead of claim processing.
- Notify Lead of Claim Coordinator when documents are missing or illegible.
- Maintain compliance with HIPAA and other security requirements.
- Performs other duties as assigned.
What experience you bring (Role Requirements)
- Minimum typing speed of 40 WPM
- Strong data entry skills with a high degree of accuracy
- Intermediate to advanced computer proficiency, including Microsoft Office Suite, Adobe Acrobat, working across multiple monitors, and the ability to quickly learn company-specific software
- Exceptional attention to detail, with strong organizational, analytical, and critical thinking skills
- Strong interpersonal and team-building skills, with the ability to collaborate across a diverse team and drive change across functional and business boundaries
Pay range: This is a non-exempt position at $15.00/hour.
What’s in it for you
- PTO, Paid Holidays, and Volunteer Days
- Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
- Tuition Reimbursement
- Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
- Remote and hybrid work options
What values we’ll share with you
- Ask why
- Think big
- Be humble
- Optimize for customer impact
- Deliver results
Equal Employment Opportunity at Machinify
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/
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