Remote Claims Adjudication Specialist

Highmark Health; Madison (WI); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine claim outcomes, correct errors, and coordinate with customers while adhering to policy.

This role emphasizes accuracy, timely processing, and adherence to HIPAA guidelines. Responsibilities include data entry, claim edits resolution, benefit eligibility determination, and maintaining detailed records.

Qualifications

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

Responsibilities

• 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 maintains communication with internal and external customers.
• Meets all production and quality standards, maintains accurate records and attends required training.

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine claim outcomes, correct errors, and coordinate with customers while adhering to policy.

This role emphasizes accuracy, timely processing, and adherence to HIPAA guidelines. Responsibilities include data entry, claim edits resolution, benefit eligibility determination, and maintaining detailed records.