Remote Claims Adjudication Specialist

Highmark Health Company; Louisiana; Hybride; USD 27 000 - 33 000; Plein temps

Résumé du poste

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

Qualifications

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

Responsabilités

• 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.

Connaissances

Communication skills

System navigation

Admin procedures

Math for adjudication

Problem solving

Claims processing OS

Data analysis

Benefits reading

Formation

High School Diploma/GED

Description du poste

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