Remote Claims Adjudication Specialist

Highmark Health; Hydaburg (AK); Remote; USD 27.000 - 33.000; Vollzeit

Zusammenfassung

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate claims. You will ensure accurate data entry, verify eligibility, and perform quality control steps in alignment with policies.

The role involves resolving inquiries and coordinating with customers while maintaining strict confidentiality. The position emphasizes timely processing, adherence to HIPAA and privacy procedures, and ongoing training.

Qualifikationen

• High School Diploma or GED is required.
• Preferred: 1 year of claim billing or processing experience.

Aufgaben

• Enter and verify claims data and determine if information is complete.
• Resolve claim edits and determine benefit eligibility for service.
• Review history records and determine final payment.
• Communicate professionally with internal and external customers and escalate issues as needed.
• Maintain records, including timekeeping and training.
• Perform other duties as assigned.

Kenntnisse

Verbal and written communication

Multisystem navigation

Administrative procedures

Math for adjudication

Problem solving

Ausbildung

High School Diploma/GED

Jobbeschreibung

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate claims. You will ensure accurate data entry, verify eligibility, and perform quality control steps in alignment with policies.

The role involves resolving inquiries and coordinating with customers while maintaining strict confidentiality. The position emphasizes timely processing, adherence to HIPAA and privacy procedures, and ongoing training.