Remote Claims Adjudication Specialist

Highmark Health; Clayton (NC); A distancia; USD 27.000 - 33.000; Jornada completa

Descripción de la vacante

Highmark Health Remote position in the United States seeks a claims processing specialist to screen, review, and adjudicate online and paper claims. You will verify data, resolve edits, determine eligibility, and adjust payments following policies and procedures.

You will collaborate with customers, maintain records, and meet production standards while handling inquiries. Strong communication, math skills, and HIPAA awareness are essential in this role.

Formación

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

Responsabilidades

• Receives and processes claims, enters/verifies data, ensures completeness and correctness.
• Resolves edits, reviews history, and determines benefit eligibility and payment determination.
• Escalates issues appropriately and maintains professional communication with customers.
• Meets production and quality standards; keeps accurate records and attends training.
• Performs other duties as assigned.

Conocimientos

Strong communication

Multi-system navigation

Clerical procedures

Mathematics for adjudication

Problem solving

Claims processing knowledge

Data review and research

Educación

High School Diploma or GED

Descripción del empleo

Highmark Health Remote position in the United States seeks a claims processing specialist to screen, review, and adjudicate online and paper claims. You will verify data, resolve edits, determine eligibility, and adjust payments following policies and procedures.

You will collaborate with customers, maintain records, and meet production standards while handling inquiries. Strong communication, math skills, and HIPAA awareness are essential in this role.