Remote Claims Adjudication Specialist

Highmark Health; Athens (GA); 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. You will determine eligibility, adjust claims, and coordinate benefits while handling inquiries from members and providers.

This role emphasizes accuracy, timely processing, and strict adherence to policies and procedures. The position requires strong communication, math skills for adjudication, and the ability to navigate multiple systems.

Qualifications

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

Responsibilities

• Enter and verify claims data for processing.
• Review edits and determine benefit eligibility.
• Communicate with customers and coordinate benefits.
• Ensure timeliness and accuracy of work and maintain records.
• Escalate issues to supervisor when needed.

Skills

Communication skills

Multi-system navigation

Clerical procedures

Mathematics for claims

Problem solving

Claims data review

Education

High School Diploma/GED

Job description

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine eligibility, adjust claims, and coordinate benefits while handling inquiries from members and providers.

This role emphasizes accuracy, timely processing, and strict adherence to policies and procedures. The position requires strong communication, math skills for adjudication, and the ability to navigate multiple systems.