Remote Claims Adjudication Specialist

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

Job summary

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. The role involves correcting errors, determining pay, deny, or return actions, and coordinating benefits as needed.

Strong communication and data analysis skills are essential to support timely, accurate claim adjustments. The ideal candidate has a High School Diploma or GED and may have 1 year of claims billing or processing experience.

Qualifications

• High School Diploma or GED required.
• 1 year of claim billing or processing experience preferred.

Responsibilities

• Receives and processes claims data, verifies completeness and accuracy.
• Determines benefit eligibility and final payment level.
• Escalates issues to supervisor while maintaining professional communication with customers.
• Meets production and quality standards and maintains accurate records.

Skills

Communication skills

Multisystem navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Claims data review

Data analysis

Claims reading

Education

High School Diploma/GED

Tools

Word processing

Records management

Job description

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. The role involves correcting errors, determining pay, deny, or return actions, and coordinating benefits as needed.

Strong communication and data analysis skills are essential to support timely, accurate claim adjustments. The ideal candidate has a High School Diploma or GED and may have 1 year of claims billing or processing experience.