Sr. High Risk Claims Specialist
Personify Health · United States · US
Utilization Review
Remote
Dentist
Demand68
Career growth55
Healthcare fit58
Remote potential45
Salary band
USD 22 – 25
5-year outlook
Stable payer-side role with incremental growth into claims leadership, quality, or stop-loss operations; compensation likely tracks insurance operations rather than clinical salaries.
Clinical license
Not required
Applicant reach
moderate
Seniority
senior
Employment type
full-time
Date found
2026-10-04
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- Profession fit
- Dentist
- Rate period
- Hourly
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Consider if you have claims, billing, coding, or insurance operations experience and want a non-clinical payer-side role. Skip if you lack claims adjudication background or prefer direct clinical work.
Who should apply
Nurses, doctors, allied health professionals, and IMGs with medical billing, coding, utilization review, or insurance claims exposure; healthcare administrators seeking payer-side operations roles.
CV angle
Translate clinical documentation, coding, case management, and payer interaction into claims adjudication language: high-acuity case review, compliance, medical terminology, ICD/CPT/HCPCS, turnaround, and client/vendor communication.
Skills to highlight
- Claims adjudication
- Medical terminology
- ICD-9/CPT/HCPCS coding
- Compliance and regulatory review
- High-dollar and specialty claims
- Stop loss claims
- Client and vendor communication
- Attention to detail
Role summary
Senior claims specialist adjudicating complex high-dollar, dialysis, and stop-loss healthcare claims, ensuring compliance, accuracy, and timely resolution while supporting clients, vendors, and team escalations.
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