Remote Claims Adjudication Specialist

Highmark Health; Bristol (RI); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processing Specialist to screen, review, and adjudicate online and paper/electronic claims. You will verify data, determine eligibility, and apply corrections according to policies.

You will interact with members and providers to resolve inquiries and ensure timely processing. The role requires strong communication, attention to detail, and the ability to navigate multiple claim processing systems.

Qualifications

• High School Diploma or GED required.
• Preferred: 1 year of claim billing or processing experience.
• Ability to review and adjudicate claims.

Responsibilities

• Receive and process claims by entering/verifying data.
• Determine eligibility and final payment after reviewing edits.
• Elevate issues to next level of supervision as appropriate and maintain professional communication with customers.
• Meet production and quality standards; maintain records and attend training.
• Other duties as assigned or requested.

Skills

Verbal & written communication

Multi-system navigation

Data entry accuracy

Claims adjudication

Problem solving

HIPAA compliance

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Processing Specialist to screen, review, and adjudicate online and paper/electronic claims. You will verify data, determine eligibility, and apply corrections according to policies.

You will interact with members and providers to resolve inquiries and ensure timely processing. The role requires strong communication, attention to detail, and the ability to navigate multiple claim processing systems.