Remote Claims Adjudication Specialist

Highmark Health; Carson City (NV); Teletrabalho; USD 27 000 - 33 000; Tempo integral

Resumo da oferta

Highmark Inc. is seeking a remote claims processor to review and adjudicate online and paper claims. You will verify data, correct errors, determine eligibility, and finalize payments in line with policies. Strong communication and data skills are essential.

The role supports timely processing, quality assurance, and interactions with customers, while adhering to HIPAA and privacy guidelines. Prior experience in claim billing is preferred.

Qualificações

• High school diploma or GED required.
• Experience with claim billing or processing preferred.
• Strong written and verbal communication skills.
• Ability to navigate multiple systems and verify data.
• Familiarity with benefit eligibility and claim adjudication.

Responsabilidades

• Receive and process claims, verify data for completeness and accuracy.
• Resolve edits and determine benefit eligibility and final payment amounts.
• Escalate issues to supervision and maintain professional communication.
• Meet production and quality standards and maintain records.

Conhecimentos

Strong communication

Multisystem navigation

Administrative procedures

Claim math adjudication

Problem solving

Claims data review

Data analysis

Reading benefits information

Investigating edits

Formação académica

High School Diploma/GED

Descrição da oferta de emprego

Highmark Inc. is seeking a remote claims processor to review and adjudicate online and paper claims. You will verify data, correct errors, determine eligibility, and finalize payments in line with policies. Strong communication and data skills are essential.

The role supports timely processing, quality assurance, and interactions with customers, while adhering to HIPAA and privacy guidelines. Prior experience in claim billing is preferred.