Remote Claims Adjudication Specialist

Highmark Health; Baton Rouge (LA); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking aClaims processing professional for remote work to review and adjudicate insurance claims. You will screen, correct errors, and conduct quality checks to determine pay, deny, or return actions in line with policy and procedures.

The role requires strong communication, attention to detail, and the ability to navigate multiple systems while adhering to HIPAA and privacy regulations. Remote work enables flexible collaboration with internal and external customers.

Qualifications

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

Responsibilities

• Receives and processes claims data, ensuring completeness and correctness.
• Resolves claim edits and determines benefit eligibility and final payment.
• Escalates issues to supervision and maintains professional communication with customers.
• Meets production and quality standards and maintains accurate records.

Skills

Communication skills

Multi-system navigation

Administrative procedures

Math for adjudication

Problem solving

Claim processing systems

Data analysis

Claims review

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking aClaims processing professional for remote work to review and adjudicate insurance claims. You will screen, correct errors, and conduct quality checks to determine pay, deny, or return actions in line with policy and procedures.

The role requires strong communication, attention to detail, and the ability to navigate multiple systems while adhering to HIPAA and privacy regulations. Remote work enables flexible collaboration with internal and external customers.