Remote Claims Adjudication Specialist

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

Job summary

Highmark Health is seeking a Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine reimbursement actions, correct errors, and coordinate with customers while ensuring timely processing under company policies.

Responsibilities include verifying data, resolving edits, and determining eligibility. The role emphasizes accuracy, reliability, and strong communication across multiple systems in a remote work setting.

Qualifications

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

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 maintains professional communication with customers.
• Meets production and quality standards and maintains accurate records and training attendance.

Skills

Communication

System navigation

Admin procedures

Math for claims

Problem solving

Claim systems

Claims analysis

Claims research

Education

High School Diploma/GED

Job description

Highmark Health is seeking a Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine reimbursement actions, correct errors, and coordinate with customers while ensuring timely processing under company policies.

Responsibilities include verifying data, resolving edits, and determining eligibility. The role emphasizes accuracy, reliability, and strong communication across multiple systems in a remote work setting.