Remote Claims Adjudication Specialist

Highmark Health; New Mexico; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate online claims, ensuring accuracy and adherence to organizational policies. You will correct errors, determine pay decisions, and coordinate benefits with members and providers as needed.

Responsibilities include processing claims, resolving edits, maintaining records, and meeting production and quality standards. A High School diploma is required, with preference for 1 year of claims experience and strong

Qualifications

• High School Diploma or GED.
• 1 year claim billing or processing experience preferred.

Responsibilities

• Receives and processes claims, enters/verifies data, ensures information is complete and correct.
• Resolves claim edits, reviews history records, and determines benefit eligibility and final payment.
• Elevates issues to supervisor as appropriate and maintains professional communication with customers.
• Meets production and quality standards, maintains timekeeping records, and attends required trainings.
• Other duties as assigned.

Skills

Verbal and written communication

Follow directions

Administrative procedures

Adjudication math

Problem solving rules

Claim processing systems

Data review skills

Reading benefits and edits

Researching claims

Job description

Highmark Health is seeking a remote Claims Processor to screen, review, and adjudicate online claims, ensuring accuracy and adherence to organizational policies. You will correct errors, determine pay decisions, and coordinate benefits with members and providers as needed.

Responsibilities include processing claims, resolving edits, maintaining records, and meeting production and quality standards. A High School diploma is required, with preference for 1 year of claims experience and strong