Senior Medical Claims Processor (Hybrid)

Communicate with providers regarding claims, payments, and issue resolution

Negotiate payment discrepancies and rejections (lead responsibility)

Maintain and strengthen provider relationships through ongoing communication

Review and manage check status, voids, reissues, and returned checks

Handle recoupment letters and payment adjustments

Support check printing and mailroom processes

Respond to provider inquiries related to payment status

Oversee daily workflow to ensure timely and accurate claims processing

Submit physical claims to the clearinghouse

Monitor group termination dashboard and pending premium payments

Track and manage pend statuses (e.g., MOOP limits, visit limits, shareable limits)

Maintain newborn eligibility tracking and non-coordinated lists

Conduct weekly and bi-weekly claims audits

Perform zero report updates and quality audits

Ensure compliance with internal policies, client guidelines, and regulatory requirements (e.g., HIPAA)

Maintain detailed documentation of claim decisions and actions taken

Serve as the first point of contact for team support, questions, and issue resolution

Act as an escalation point for complex or high-value claims

Mentor and support junior claims processors; provide training and guidance

Conduct initial performance coaching and development discussions

Lead or provide backup support for daily team huddles

Participate in quality assurance reviews and process improvement initiatives

Hybrid work environment

High-volume, fast-paced, deadline-driven setting

Extended screen time required

When we say free, we mean no money out of your paycheck and no cost when you need care:

No monthly premiums

No cost to add your spouse or children

No deductibles (we reimburse them)

No out-of-pocket maximums

This benefit alone can save families tens of thousands of dollars.

Salary range: $50,000 - $55,000

FREE healthcare for you and your entire family

Dental & Vision insurance

Paid time off & sick time

401(k) access

A mission-driven team that believes in doing the right thing

If you’re looking for more than just a job—and want to help reshape how healthcare works for families—we’d love to hear from you.

Redirect Health is an Equal Opportunity Employer (EOE). Employment with Redirect Health is at-will. Nothing in this job posting or the application process creates a contract or guarantee of employment. Please note this job description is not designed to contain a comprehensive listing of activities, duties, or responsibilities required for this role. Duties, responsibilities, and activities may change at any time with or without notice. Redirect Health does not provide employment-based visa sponsorship now or in the future for this position. Applicants must be currently authorized to work in the United States without sponsorship.

The pay range for this role is:

50,000 - 55,000 USD per year (Phoenix)

Healthcare shouldn’t be something you worry about when taking care of your family.

That’s why when you join Redirect Health, your healthcare costs nothing out of your paycheck—and the same is true for your spouse and children.

No deductibles

No surprise medical bills

Most team members avoid tens of thousands of dollars in healthcare costs compared to traditional health plans.

This isn’t a perk. It’s part of our mission.

Redirect Health exists to make healthcare affordable for small businesses and people who can’t afford traditional employer insurance.

We help real people navigate a system that is often confusing, expensive, and frustrating—and we do it with empathy, accountability, and simplicity.

If you want your work to matter to families every single day, you’ll find purpose here.

At Redirect Health, our values guide how we show up for each other, our clients, and our members.

We do our best work when we:

Obsess Over People – We are always helpful, friendly, and human

Own It to Completion – If we take something on, we see it through

Always Improve & Adapt – We learn quickly and adjust without ego

Start with “Yes, We Can Help You” – We lead with solutions

Succeed as a Team – We win through trust and collaboration

Detest Waste & Unnecessary Complexity – We simplify to focus on what matters