Operations Support Specialist I

Overview:

Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform - bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

Responsibilities:

Ready To Keep Fee Processing and Appeals Moving Accurately Across a High-Volume Claims Operation?

Why This Role Matters

When invoices are misallocated or appeals go unlogged, members and clients feel it. This role sits at the center of daily fee processing and appeals intake - monitoring inboxes, reconciling vendor invoices, resolving credits, and making sure nothing falls through the cracks. The work is detailed and deadline-driven, and getting it right matters.

What You'll Actually Do

Manage appeals intake: Monitor email, system mailboxes, and scan folders in the claims system to review and log appeals as they arrive.

Process vendor invoices end-to-end: Receive, review, and process invoices across multiple vendors - including PBM vendors - allocating fees via Excel and creating corresponding bills in the claims system.

Resolve invoice credits: Research and resolve credit entries, maintain credit data, and apply credits accurately and on schedule.

Stay current on procedures and group instructions: Keep up with procedural updates, guidelines, and group-specific instructions that govern how work gets processed.

Back up team operations as needed: Step in to support colleagues and complete additional assigned tasks - overpayment calls, document retrieval, and other operational work as directed.

Qualifications:

What You Bring to Our Team

Education & Experience

• High school diploma or GED
• Knowledge of medical terminology and ICD-10, CPT, and HCPCS coding
• Experience working in medical insurance companies
• Experience with QicLink and/or Eldorado claims systems is a plus

Technical Skills

• Proficiency in Word, Excel, and Outlook
• Working understanding of medical claims processing

Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.

Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to [email protected]. View all legitimate openings at personifyhealth.com/careers.