Remote Claims Adjudication Specialist

Highmark Health; Mississippi; Remote; USD 27.000 - 33.000; Vollzeit

Zusammenfassung

Highmark Health is seeking a claims processor to screen, review, and adjudicate claims remotely. You will verify claim data, determine eligibility, and finalize payments while upholding policy guidelines.

The role requires strong communication and the ability to navigate multiple systems to resolve inquiries and ensure accuracy. The position emphasizes timely processing, adherence to quality standards, and interaction with customers.

Qualifikationen

• Must have High School Diploma or GED.
• Preferred 1 year claim billing or processing experience.

Aufgaben

• Receives and processes claims data, verifies information.
• Resolves edits and determines benefit eligibility and final payment.
• Escalates issues to supervisor and maintains professional communication with customers.
• Meets production and quality standards and maintains timekeeping records.
• Other duties as assigned or requested.

Kenntnisse

Communication skills

Multi-system navigation

Office procedures

Math skills

Problem solving

Claim processing OS

Claims analysis

Benefits interpretation

Research skills

Ausbildung

High School Diploma/GED

Jobbeschreibung

Highmark Health is seeking a claims processor to screen, review, and adjudicate claims remotely. You will verify claim data, determine eligibility, and finalize payments while upholding policy guidelines.

The role requires strong communication and the ability to navigate multiple systems to resolve inquiries and ensure accuracy. The position emphasizes timely processing, adherence to quality standards, and interaction with customers.