Remote Claims Adjudication Specialist

Highmark Health; Hartford (CT); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processor to review and adjudicate claims, correct errors, and perform quality checks on paper and electronic submissions.

You will determine whether to return, deny, or pay claims in accordance with policy and procedures. The role involves analyzing inquiries, coordinating benefits, and providing technical assistance for researching and resolving issues, all while ensuring timely processing and compliance with HIPAA and privacy guidelines.

Qualifications

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

Responsibilities

• Receives and processes claims data; verifies completeness and correctness.
• Resolves claim edits and determines benefit eligibility and final payment.
• Escalates issues to supervision while maintaining professional communication with customers.
• Meet production and quality standards; maintain accurate timekeeping and training records.
• Perform other duties as assigned.

Skills

Communication

Multitasking

Admin procedures

Math for claims

Problem solving

Processing systems

Data review

Research & reports

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Processor to review and adjudicate claims, correct errors, and perform quality checks on paper and electronic submissions.

You will determine whether to return, deny, or pay claims in accordance with policy and procedures. The role involves analyzing inquiries, coordinating benefits, and providing technical assistance for researching and resolving issues, all while ensuring timely processing and compliance with HIPAA and privacy guidelines.