Remote Claims Adjudication Specialist

Highmark Health; California City (CA); 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, ensuring accuracy and policy compliance. You will correct errors, perform quality control, and determine whether to deny, pay, or return claims while coordinating with members and providers.

The role focuses on timely processing, data verification, and accurate recordkeeping, with emphasis on attention to detail and the ability to navigate multiple claim systems and procedures.

Qualifications

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

Responsibilities

• Process and verify claims data and ensure accuracy.
• Determine benefit eligibility and final payment amounts.
• Escalate issues appropriately and communicate with customers.
• Meet production and quality standards and maintain records.

Skills

Verbal & written communication

Multitasking across systems

Attention to detail

Analytical thinking

Problem solving

Adjudicate claims

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, ensuring accuracy and policy compliance. You will correct errors, perform quality control, and determine whether to deny, pay, or return claims while coordinating with members and providers.

The role focuses on timely processing, data verification, and accurate recordkeeping, with emphasis on attention to detail and the ability to navigate multiple claim systems and procedures.