Remote Claims Adjudication Specialist

Highmark Health; Cheyenne (WY); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote claims processor to screen, review, and adjudicate claims with precision and integrity.

You will verify data accuracy and determine pay outcomes following policy guidelines. You will resolve claim edits, assess benefit eligibility, and collaborate with customers and internal teams to ensure timely, accurate payment decisions while maintaining documentation and compliance standards.

Qualifications

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Ability to review claims and determine eligibility and payments.
• Knowledge of claim processing systems beneficial.

Responsibilities

• Process and verify claims data for completeness and accuracy.
• Resolve claim edits and determine benefit eligibility.
• Communicate with internal/external customers about claim status.
• Maintain records and ensure timeliness and quality standards.

Skills

Communication

Multi-system navigation

Data entry

Claims adjudication

Problem solving

Reading benefits

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a remote claims processor to screen, review, and adjudicate claims with precision and integrity.

You will verify data accuracy and determine pay outcomes following policy guidelines. You will resolve claim edits, assess benefit eligibility, and collaborate with customers and internal teams to ensure timely, accurate payment decisions while maintaining documentation and compliance standards.