Remote Claims Adjudication Specialist

Highmark Health Company; Muncie (IN); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote Claims Examiner to screen, review, and adjudicate online and paper/electronic claims. You will determine approval/denial decisions following policy guidelines and coordinate with customers as needed.

The role requires strong communication, accuracy, and the ability to work across multiple claims processing systems, while maintaining compliance with HIPAA and internal policies.

Qualifications

• Strong verbal and written communication skills.
• Ability to navigate multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and systems.

Responsibilities

• Process and enter claims data; verify information is complete and correct.
• Review edits and determine benefit eligibility and final payment.
• Escalate issues appropriately and communicate with customers professionally.
• Meet production and quality standards and maintain accurate records.

Skills

Communication skills

System navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Claim processing systems

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a remote Claims Examiner to screen, review, and adjudicate online and paper/electronic claims. You will determine approval/denial decisions following policy guidelines and coordinate with customers as needed.

The role requires strong communication, accuracy, and the ability to work across multiple claims processing systems, while maintaining compliance with HIPAA and internal policies.