Remote Claims Adjudication Specialist

Highmark Health; Louisiana; A distancia; USD 27.000 - 33.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a claims processor to screen, review, evaluate online entry, correct errors, and adjudicate paper/electronic claims according to company policies.

You will verify data, determine eligibility, adjust claims, and coordinate benefits while maintaining timely processing and accurate records. This remote role supports customer inquiries and quality control initiatives.

Formación

• High School Diploma or GED required.
• 1 year of claims billing or processing experience preferred.

Responsabilidades

• Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct.
• Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment levels to arrive at final payment determination.
• Elevates issues to next level of supervision as appropriate and ensures a professional line of communication is maintained with internal and external customers.
• Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records, including timekeeping records and attends all required training classes.
• Other duties as assigned or requested.

Conocimientos

Communication skills

System navigation

Administrative procedures

Mathematical adjudication

Problem solving

Claim processing OS

Data analysis

Benefits reading & determinations

Research & reporting

Educación

High School Diploma/GED

Descripción del empleo

Highmark Inc. is seeking a claims processor to screen, review, evaluate online entry, correct errors, and adjudicate paper/electronic claims according to company policies.

You will verify data, determine eligibility, adjust claims, and coordinate benefits while maintaining timely processing and accurate records. This remote role supports customer inquiries and quality control initiatives.