Remote Claims Adjudication Clerk

Highmark Health; North Dakota; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a claims adjudication specialist responsible for screening, reviewing, and final adjudication of claims, ensuring accurate processing and timely action. You will correct errors, review inquiries, and coordinate benefits while adhering to organizational policies and HIPAA/privacy requirements.

The role requires attention to detail, strong communication, and the ability to work across multiple systems.

Qualifications

• Strong verbal and written communication required.
• Ability to navigate multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and records management.
• Ability to use mathematics to adjudicate claims.

Responsibilities

• Receives and processes claims data; verifies information.
• Determines benefit eligibility and final payment.
• Escalates issues to supervision and maintains professional communication.
• Meets production and quality standards; maintains records and attends trainings.
• Other duties as assigned.

Skills

Verbal and written communication

Multisystem navigation

Administrative procedures

Claims adjudication

Education

High School Diploma/GED

Job description

Highmark Health is seeking a claims adjudication specialist responsible for screening, reviewing, and final adjudication of claims, ensuring accurate processing and timely action. You will correct errors, review inquiries, and coordinate benefits while adhering to organizational policies and HIPAA/privacy requirements.

The role requires attention to detail, strong communication, and the ability to work across multiple systems.