Remote Claims Adjudication Specialist

Highmark Health; Alabama; À distance; USD 27 000 - 33 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a claims adjudicator to screen, review, and finalize electronic and paper claims. You will determine whether to return, deny, or pay claims following policy, conduct corrective actions, and coordinate benefits as needed. Strong communication and data analysis skills are essential to succeed.

The role emphasizes timely and accurate claim adjustments, with responsibilities spanning audits, inquiries, and system changes, while supporting customers remotely.

Qualifications

• High School Diploma or GED required.
• Experience in claim billing or processing preferred.

Responsabilités

• Receives and processes claims to include entering/verifying data and ensuring completeness.
• Determines benefit eligibility and reviews payment levels for final determination.
• Elevates issues to supervisor while maintaining professional communication with customers.
• Meets production and quality standards and maintains accurate records including timekeeping.
• Performs other duties as assigned or requested.

Connaissances

Verbal communication

Written communication

System navigation

Word processing

Mathematical adjudication

Problem solving

Claim processing systems

Data analysis

Benefits reading

Claims research

Formation

High School Diploma/GED

Description du poste

Highmark Inc. is seeking a claims adjudicator to screen, review, and finalize electronic and paper claims. You will determine whether to return, deny, or pay claims following policy, conduct corrective actions, and coordinate benefits as needed. Strong communication and data analysis skills are essential to succeed.

The role emphasizes timely and accurate claim adjustments, with responsibilities spanning audits, inquiries, and system changes, while supporting customers remotely.