Remote Claims Adjudication Specialist

Highmark Health; Jackson (MS); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote Claims Processing Specialist to screen, review, and adjudicate paper and electronic claims. You will verify data, correct errors, and determine pay, deny, or return actions in line with policies.

The role requires strong communication, math, and problem-solving skills, with experience in claim processing systems and ensuring timely, accurate outcomes. Remote work is offered with standard adherence to HIPAA and privacy guidelines.

Qualifications

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

Responsibilities

• Receives and processes claims data, verifies completeness and correctness.
• Resolves claim edits and determines benefit eligibility for services.
• Reviews payment levels to arrive at final payment determination.
• Maintains accurate records and adheres to production and quality standards.
• Performs other duties as assigned or requested.

Skills

Communication skills

Multitasking

Administrative procedures

Mathematics for claims

Problem solving

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a remote Claims Processing Specialist to screen, review, and adjudicate paper and electronic claims. You will verify data, correct errors, and determine pay, deny, or return actions in line with policies.

The role requires strong communication, math, and problem-solving skills, with experience in claim processing systems and ensuring timely, accurate outcomes. Remote work is offered with standard adherence to HIPAA and privacy guidelines.