Remote Claims Adjudication Specialist

Highmark Health Company; Louisiana; Híbrido; USD 27 000 - 33 000; Tempo integral

Resumo da oferta

Highmark Inc. is seeking a Claims Processor to remotely screen, review, and adjudicate claims, ensuring accuracy and compliance with policies. The role involves data entry, error correction, and collaboration with customers and internal teams to resolve claims efficiently.

Responsibilities include verifying data, resolving edits, determining eligibility, and maintaining meticulous records. Strong communication and system navigation skills are essential for timely processing and adherence to

Qualificações

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

Responsabilidades

• Enter and verify claims data accurately.
• Determine if claim information is complete and correct.
• Resolve claim edits and review history records to determine benefit eligibility.
• Make final payment determinations and adjust as needed.
• Elevate complex issues to supervisor and maintain professional communication.
• Meet production and quality standards and maintain accurate records.

Conhecimentos

Communication skills

System navigation

Admin procedures

Math for adjudication

Problem solving

Claims processing OS

Data analysis

Benefits reading

Formação académica

High School Diploma/GED

Descrição da oferta de emprego

Highmark Inc. is seeking a Claims Processor to remotely screen, review, and adjudicate claims, ensuring accuracy and compliance with policies. The role involves data entry, error correction, and collaboration with customers and internal teams to resolve claims efficiently.

Responsibilities include verifying data, resolving edits, determining eligibility, and maintaining meticulous records. Strong communication and system navigation skills are essential for timely processing and adherence to