Claims Operations Specialist
About The Position
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. Ready to Be the Face of Member Service Excellence? Why This Role Matters Most claims specialists work behind the scenes—you'll be front and center. As our onsite Claims Operations Specialist in Los Angeles, California, you'll serve as the primary point of contact for walk-in clients and members while managing claims adjudication responsibilities. This dual role means you're solving problems in real-time, processing complex claims with precision, and ensuring every member interaction reinforces trust in our service. Your ability to balance technical claims expertise with compassionate member service directly impacts satisfaction, retention, and our reputation for going above and beyond.
Requirements
- High school diploma or equivalent required
- 3+ years healthcare claims examination or adjudication experience
- Prior experience with both manual and automated claims processing
- Strong knowledge of medical terminology, CPT/ICD-10 coding, and healthcare billing procedures
- Proficient in Microsoft Office (Word, Excel, Outlook)
- Ability to maintain confidentiality and handle sensitive information with discretion
- Serve as the onsite liaison near Eagle Rock, Los Angeles, California (90041)
- Reside within driving distance of the office
- Must be available Monday–Thursday, 8:00 AM – 4:30 PM, and Friday, 7:00 AM – 3:30 PM
Nice To Haves
- Associate or Bachelor's degree in healthcare administration or related field preferred
- Expertise in multiple claims processing platforms a plus
Responsibilities
- Serve as the onsite liaison: Act as primary point of contact for all walk-in clients, providing professional, timely assistance for member concerns and questions.
- Process claims accurately: Review, analyze, and adjudicate healthcare claims to ensure accuracy, completeness, and compliance with policies and regulatory standards.
- Conduct member interviews: Meet with claimants in-person to obtain required information, clarify discrepancies, and explain claims processes and requirements clearly.
- Respond to inquiries: Handle questions from walk-ins, callers, and written correspondence regarding health plans, policies, and procedures with professionalism.
- Maintain quality standards: Complete thorough review and examination of each claim to ensure proper handling in accordance with company policies and procedures.
- Ensure accurate setup: Review and understand plan documents and vendor information, verify proper system setup during claims processing, and identify potential errors or issues to management.
- Meet production requirements: Complete claims tasks in timely manner while maintaining quality standards and production benchmarks.
- Support client relationships: Coordinate with internal staff and vendor partners to ensure customer and member satisfaction across all touchpoints.
- Contribute to team success: Support management team with special projects and requests as business needs require.
Benefits
- Competitive base salary and benefits effective day one
- Comprehensive medical and dental through our own health solutions (yes, we use what we build)
- Paid Time Off—rest and recharge time is non-negotiable
- Mental health support, retirement planning, and financial protection
- Professional development with clear career progression and learning budgets
- Mission-driven culture where diverse perspectives drive real impact on people's health
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
