Remote Claims Adjudication Specialist

Highmark Health; Annapolis (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.

You will determine eligibility, correct errors, and perform quality control to ensure accurate payment determinations in a remote environment. The role requires attention to detail, good communication skills, and the ability to navigate multiple systems to process claims while meeting production and quality standards.

Qualifications

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

Responsibilities

• Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct.
• Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment levels to arrive at final payment determination.
• Elevates issues to next level of supervision as appropriate and ensures a professional line of communication is maintained with internal and external customers.
• Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records, including timekeeping records and attends all required training classes.
• Other duties as assigned or requested.

Skills

Strong communication

Multi-system navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Claims processing knowledge

Education

High School Diploma/GED

Job description

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

You will determine eligibility, correct errors, and perform quality control to ensure accurate payment determinations in a remote environment. The role requires attention to detail, good communication skills, and the ability to navigate multiple systems to process claims while meeting production and quality standards.