Remote Claims Adjudication Specialist

Highmark Health; Clifton (TX); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a Claims Processor to screen, review, and adjudicate online and paper claims remotely. You will determine pay, deny, or return claims, correct errors, and assist customers with inquiries while maintaining compliance with HIPAA and company policies.

Responsibilities include entering and verifying data, resolving edits, ensuring accuracy, and meeting production standards. This role requires attention to detail, strong communication, and the ability to navigate multiple

Qualifications

• High School Diploma or GED required.
• Experience with claims processing is a plus.
• Ability to work remotely and manage multiple systems.

Responsibilities

• Screens, reviews, and adjudicates claims per policies.
• Enters and verifies claims data; determines completeness and correctness.
• Resolves edits and determines benefit eligibility and final payment.
• Maintains records and meets production and quality standards.
• Supports customer inquiries and other duties as assigned.

Skills

Strong communication

Systems navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Claims processing systems

Data review skills

Benefits review

Education

High School Diploma or GED

Tools

Claims processing software

Data entry systems

Job description

Highmark Health is seeking a Claims Processor to screen, review, and adjudicate online and paper claims remotely. You will determine pay, deny, or return claims, correct errors, and assist customers with inquiries while maintaining compliance with HIPAA and company policies.

Responsibilities include entering and verifying data, resolving edits, ensuring accuracy, and meeting production standards. This role requires attention to detail, strong communication, and the ability to navigate multiple