Remote Claims Adjudication Specialist

Highmark Health; Manchester (NH); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a claims processor to screen and review online entries, correct errors, and adjudicate claims following policy. You will coordinate benefits, interact with customers, and support timely, accurate claim adjustments across various inquiries.

Essential duties include processing and verifying data, resolving edits, and ensuring payment determinations are correct. The role requires strong communication, multi-system navigation, and adherence to HIPAA standards.

Qualifications

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

Responsibilities

• Receives and processes claims, entering/verifying data and ensuring information is complete and correct.
• Resolves edits, reviews history, and determines benefit eligibility and final payment.
• Escalates issues to supervision while maintaining professional communication with customers.
• Meets production and quality standards and keeps accurate records, including timekeeping.
• Other duties as assigned.

Skills

Strong communication

System navigation

Clerical procedures

Math for adjudication

Problem solving

Claim processing

Education

High School Diploma or GED

Job description

Highmark Inc. is seeking a claims processor to screen and review online entries, correct errors, and adjudicate claims following policy. You will coordinate benefits, interact with customers, and support timely, accurate claim adjustments across various inquiries.

Essential duties include processing and verifying data, resolving edits, and ensuring payment determinations are correct. The role requires strong communication, multi-system navigation, and adherence to HIPAA standards.