Remote Claims Adjudication Specialist

Highmark Health; Atlanta (GA); 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.

This remote role requires ensuring data accuracy, applying policies, and finalizing claim decisions with a focus on timely processing. Responsibilities include entering claims, verifying information, resolving edits, determining eligibility and payment levels, and maintaining clear communication with internal and external customers.

Qualifications

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Strong verbal and written communication skills; ability to navigate multiple systems.

Responsibilities

• Receive and process claims; verify data integrity.
• Resolve edits and determine benefit eligibility and final payment.
• Elevate issues appropriately and maintain professional communication with customers.
• Meet production and quality standards; maintain accurate records and complete training.

Skills

Verbal communication

Written communication

Multi-system navigation

Mathematical adjudication

Problem solving

Claims data analysis

Attention to detail

Researching and resolving inquiries

Education

High School Diploma/GED

Tools

Claims processing systems

Job description

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

This remote role requires ensuring data accuracy, applying policies, and finalizing claim decisions with a focus on timely processing. Responsibilities include entering claims, verifying information, resolving edits, determining eligibility and payment levels, and maintaining clear communication with internal and external customers.