Remote Claims Adjudication Specialist

Highmark Health; Oklahoma City (OK); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a remote Claims Adjudicator responsible for screening, reviewing, and final adjudication of claims. You will verify data, resolve edits, and determine eligibility and payment levels in accordance with policies.

The role also involves research, inquiries, and detailed note-taking to support audits and system changes. The position requires a High School Diploma/GED and may prefer 1 year of claim billing/processing experience.

Qualifications

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

Responsibilities

• Receives and processes claims data and verifies completeness.
• 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 accurate timekeeping records.
• Performs other duties as assigned.

Skills

Communication

Multisystem navigation

Admin procedures

Mathematics for adjudication

Problem solving

Claims processing OS

Data analysis

Benefits/claims edits

Research & reporting

Education

High School Diploma/GED

Job description

Highmark Health is seeking a remote Claims Adjudicator responsible for screening, reviewing, and final adjudication of claims. You will verify data, resolve edits, and determine eligibility and payment levels in accordance with policies.

The role also involves research, inquiries, and detailed note-taking to support audits and system changes. The position requires a High School Diploma/GED and may prefer 1 year of claim billing/processing experience.