Remote Claims Adjudication Specialist

Highmark Health; Central City (NE); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. seeks a Claims Adjudicator to screen, review and adjudicate online and paper/electronic claims. You will verify data, determine eligibility and resolve edits while following policies and procedures.

The role requires precise data entry, strong communication and adherence to HIPAA standards. The position is remote, offering growth opportunities in a regulated benefits environment, with emphasis on accuracy, customer service, and timely claim resolution.

Qualifications

• Strong verbal and written communication skills.
• Ability to navigate multiple systems simultaneously.
• Knowledge of administrative procedures and record keeping.

Responsibilities

• Enter and verify claims data; ensure information is complete and correct.
• Resolve claim edits and determine benefit eligibility; review payment levels.
• Escalate issues to supervision and maintain professional communication with customers.
• Meet production and quality standards; maintain accurate timekeeping records; attend training.
• Perform other duties as assigned.

Skills

Communication

Multi-system access

Administrative procedures

Mathematics for adjudication

Problem solving

Claims processing systems

Data analysis

Record keeping

Education

High School Diploma/GED

Job description

Highmark Inc. seeks a Claims Adjudicator to screen, review and adjudicate online and paper/electronic claims. You will verify data, determine eligibility and resolve edits while following policies and procedures.

The role requires precise data entry, strong communication and adherence to HIPAA standards. The position is remote, offering growth opportunities in a regulated benefits environment, with emphasis on accuracy, customer service, and timely claim resolution.