Remote Claims Adjudication Specialist

Highmark Health; Maryland; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate online and paper claims. You will verify data, resolve edits, determine eligibility, and ensure timely, accurate processing per policy.

You may support benefits coordination and respond to inquiries while maintaining HIPAA compliance. The role requires a high school diploma or GED, with preferred experience in claim billing/processing and familiarity with claim processing systems.

Qualifications

• High School Diploma or GED is required.
• 1 year claim billing or processing experience preferred.
• Experience with claim adjudication and processing guidelines is a plus.

Responsibilities

• Receive and process claims data entries and verify accuracy.
• Resolve claim edits and determine benefit eligibility and final payment.
• Review processing history and determine corrective actions as needed.

Skills

Communication skills

Attention to detail

Multiple system navigation

Problem solving

Adjudication

Data entry

HIPAA awareness

Education

High school diploma

Tools

Claim processing software

Job description

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate online and paper claims. You will verify data, resolve edits, determine eligibility, and ensure timely, accurate processing per policy.

You may support benefits coordination and respond to inquiries while maintaining HIPAA compliance. The role requires a high school diploma or GED, with preferred experience in claim billing/processing and familiarity with claim processing systems.