Remote Claims Adjudication Specialist

Highmark Health; Minneota (MN); 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 ensure data accuracy, determine eligibility, and coordinate with customers while maintaining timely processing and compliance with policies.

The role requires attention to detail, strong communication, and the ability to navigate multiple system platforms to resolve claims efficiently.

Qualifications

• Strong verbal and written communication skills.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to use mathematics to adjudicate claims.
• Ability to solve problems within pre-defined methods and guidelines.
• Knowledge of operating systems specific to claim processing.
• Ability to review claims and analyze critical data.
• Reading benefits, investigating edits and making benefit determinations as required in adjusting and adjudicating most types of claims.
• Researches and finalizes claims, adjustments, inquiries and reports as required.

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 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.

Job description

Highmark Health is seeking a remote claims processor to screen, review, and adjudicate online and paper claims. You will ensure data accuracy, determine eligibility, and coordinate with customers while maintaining timely processing and compliance with policies.

The role requires attention to detail, strong communication, and the ability to navigate multiple system platforms to resolve claims efficiently.