Remote Claims Adjudication Specialist

Highmark Health; Clayton (MO); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a claims processing specialist to screen, review, and adjudicate online and paper claims, ensuring accuracy and adherence to policies. You will determine eligibility, correct errors, and coordinate with customers as needed in a remote environment.

The role emphasizes timely processing, data verification, and strict quality standards. Candidates should have a high school diploma and prefer prior claim billing experience to support efficient problem resolution.

Qualifications

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

Responsibilities

• Receives and processes claims, entering/verifying data.
• Determines if claim information is complete and correct.
• Reviews edits and determines benefit eligibility and final payment.
• Escalates issues to supervisor and maintains professional communication with customers.
• Meets production and quality standards; maintains accurate timekeeping and attends required trainings.
• Other duties as assigned.

Skills

Communication skills

Attention to detail

Problem solving

Data analysis

Documentation

Time management

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a claims processing specialist to screen, review, and adjudicate online and paper claims, ensuring accuracy and adherence to policies. You will determine eligibility, correct errors, and coordinate with customers as needed in a remote environment.

The role emphasizes timely processing, data verification, and strict quality standards. Candidates should have a high school diploma and prefer prior claim billing experience to support efficient problem resolution.