Remote Claims Adjudication Specialist

Highmark Health; Lorida (FL); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a Claims Review Specialist to screen, review, and adjudicate online and paper claims, ensuring accuracy and adherence to policy. You will correct errors, coordinate benefits, and respond to inquiries while maintaining timely processing standards.

The role is remote with a minimum educational requirement of a High School Diploma/GED and a preference for 1 year of claim billing/processing experience. Strong communication and data-analysis skills are essential.

Qualifications

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Strong verbal and written communication skills; ability to navigate multiple systems and manage data.

Responsibilities

• Receives and processes claims data; verifies completeness and correctness.
• Resolves edits and determines benefit eligibility and final payment.
• Elevates issues to supervision and maintains professional communication with customers.
• Meets production and quality standards; maintains accurate timekeeping and training records.
• Performs other duties as assigned.

Skills

Verbal communication

Written communication

Attention to detail

Multisystem navigation

Numerical/claims adjudication

Problem solving

Data review

Education

High School Diploma/GED

Job description

Highmark Health is seeking a Claims Review Specialist to screen, review, and adjudicate online and paper claims, ensuring accuracy and adherence to policy. You will correct errors, coordinate benefits, and respond to inquiries while maintaining timely processing standards.

The role is remote with a minimum educational requirement of a High School Diploma/GED and a preference for 1 year of claim billing/processing experience. Strong communication and data-analysis skills are essential.