Remote Claims Adjudication Specialist

Highmark Health; Accident (MD); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processor to screen, review, and adjudicate online and paper claims, ensuring accuracy and adherence to policies.

You will enter and verify data, determine eligibility, resolve edits, and communicate with customers while maintaining timely, compliant processing. Remote work options are available.

This role requires strong attention to detail and knowledge of HIPAA privacy requirements.

Qualifications

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Familiarity with HIPAA and privacy practices is a plus.

Responsibilities

• Receives and processes claims, verifies data, and checks for completeness and correctness.
• Resolves edits and determines benefit eligibility and final payment amounts.
• Escalates issues to supervisors as needed and maintains professional communication with customers.
• Meets production and quality standards; keeps accurate timekeeping records and attends training.
• Other duties as assigned or requested.

Skills

Communication skills

Multi-system navigation

Admin procedures

Data analysis

Problem solving

Claims systems

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Processor to screen, review, and adjudicate online and paper claims, ensuring accuracy and adherence to policies.

You will enter and verify data, determine eligibility, resolve edits, and communicate with customers while maintaining timely, compliant processing. Remote work options are available.

This role requires strong attention to detail and knowledge of HIPAA privacy requirements.