Remote Claims Adjudication Specialist

Highmark Health; Maryland City (MD); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a detail-oriented claims adjudication specialist for remote processing of online and paper/electronic claims. You will review, correct, and adjudicate claims according to policy, determine eligibility, and resolve inquiries while ensuring timely and accurate processing.

The role requires strong communication, data entry accuracy, and the ability to navigate multiple systems. Prior billing/claims experience is preferred; HS diploma or GED is required.

Qualifications

• High School Diploma or GED is required.
• 1 year of claim billing or processing experience preferred.
• Proven ability to read and interpret benefit information and apply policy guidelines.

Responsibilities

• Receives and processes claims data entry and verification.
• Determines claim completeness and accuracy before processing.
• Reviews benefit eligibility and payment levels to finalize payments.
• Escalates issues to supervision when needed and maintains professional communication with customers.
• Meets production and quality standards and maintains accurate records.

Skills

Strong communication

Attention to detail

Multitasking

Data entry accuracy

Claims adjudication

Navigate multiple systems

Education

High School Diploma/GED

Job description

Highmark Health is seeking a detail-oriented claims adjudication specialist for remote processing of online and paper/electronic claims. You will review, correct, and adjudicate claims according to policy, determine eligibility, and resolve inquiries while ensuring timely and accurate processing.

The role requires strong communication, data entry accuracy, and the ability to navigate multiple systems. Prior billing/claims experience is preferred; HS diploma or GED is required.