Remote Claims Adjudication Specialist

Highmark Health; Florida; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a detail-oriented Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will verify data, determine eligibility, calculate benefits, and coordinate with customers as needed.

This role emphasizes timely, accurate adjustments and adherence to HIPAA and company policies. The position supports a remote work arrangement, with pay ranges noted for entry-level to mid-level responsibilities.

Qualifications

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

Responsibilities

• Receives and processes claims data, verifies completeness and accuracy.
• Determines eligibility and payment levels by reviewing edits and history records.
• Escalates issues to supervision while maintaining professional communication with customers.
• Meets production and quality standards, maintains records and timekeeping.
• Performs other duties as assigned or requested.

Skills

Strong communication

Multi-system navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Claims processing systems

Data analysis

Benefits reading and determinations

Research and finalizing claims

Education

High School Diploma/GED

Job description

Highmark Health is seeking a detail-oriented Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will verify data, determine eligibility, calculate benefits, and coordinate with customers as needed.

This role emphasizes timely, accurate adjustments and adherence to HIPAA and company policies. The position supports a remote work arrangement, with pay ranges noted for entry-level to mid-level responsibilities.