Remote Claims Adjudication Specialist

Highmark Health; Montpelier (VT); À distance; USD 27 000 - 33 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a dedicated claims processing specialist to screen, review, and adjudicate online entries and paper claims. You will perform quality control, correct errors, and determine whether to return, deny, or pay claims following policies.

The role emphasizes timely processing, accurate record keeping, and coordination with customers. Remote work option with HIPAA/privacy compliance; requires a High School Diploma; preferred 1 year claim billing/processing experience.

Qualifications

• Required: High School Diploma/GED.
• Preferred: 1 year claim billing or processing experience.

Responsabilités

• Receives and processes claims data entry and verification.
• Resolves edits and determines benefit eligibility for service.
• Reviews history records and final payment determination.
• Maintains professional communication with customers.
• Meets production/quality standards and maintains records.

Connaissances

Strong verbal and written comms

Navigate multiple systems

Administrative procedures

Mathematics for adjudication

Problem solving in predefined methods

Operating systems for claims

Reviewing claims data

Reading benefits & edits

Formation

High School Diploma/GED

Description du poste

Highmark Inc. is seeking a dedicated claims processing specialist to screen, review, and adjudicate online entries and paper claims. You will perform quality control, correct errors, and determine whether to return, deny, or pay claims following policies.

The role emphasizes timely processing, accurate record keeping, and coordination with customers. Remote work option with HIPAA/privacy compliance; requires a High School Diploma; preferred 1 year claim billing/processing experience.