Remote Claims Adjudication Specialist

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

Job summary

Highmark Inc. is seeking a claims processor to screen, review, and adjudicate online and paper claims, correcting errors and applying policies to decide whether to return, deny, or pay claims.

You will enter and verify data, assess eligibility, resolve edits, and communicate with members and providers while maintaining HIPAA standards and timely processing. The role requires attention to detail and multi-system navigation.

Qualifications

• Required: High School Diploma or GED.
• Preferred: 1 year claim billing or processing experience.

Responsibilities

• Receives and processes claims, entering and verifying data.
• Determines if claim information is complete and correct.
• Reviews edits and determines benefit eligibility and final payment.
• Maintains timely and accurate records and communicates with customers.
• Other duties as assigned or requested.

Skills

Strong communication

System navigation

Data entry accuracy

Analytical thinking

Problem solving

Claims processing knowledge

Education

High School Diploma/GED

Tools

HIPAA compliance software

Job description

Highmark Inc. is seeking a claims processor to screen, review, and adjudicate online and paper claims, correcting errors and applying policies to decide whether to return, deny, or pay claims.

You will enter and verify data, assess eligibility, resolve edits, and communicate with members and providers while maintaining HIPAA standards and timely processing. The role requires attention to detail and multi-system navigation.