Remote Claims Adjudication Specialist

Highmark Health; Olympia (WA); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a claims processor to screen, review, and adjudicate online and paper claims. You will determine pay, deny, or return claims, and assist customers with inquiries while adhering to HIPAA and company policies.

This remote role emphasizes accuracy and timely processing in a structured environment. The position requires strong communication skills, the ability to navigate multiple systems, and a focus on producing quality results.

Qualifications

• Requires High School Diploma/GED.
• Preferred: 1 year claim billing or processing experience.
• Ability to navigate multiple systems and maintain accuracy.

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 ensures a professional line of communication is maintained with internal and external customers.
• Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records, including timekeeping records and attends all required training classes.
• Other duties as assigned or requested.

Skills

Verbal communication

Written communication

Analytical thinking

Multitasking

Attention to detail

Problem solving

System navigation

Data entry

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a claims processor to screen, review, and adjudicate online and paper claims. You will determine pay, deny, or return claims, and assist customers with inquiries while adhering to HIPAA and company policies.

This remote role emphasizes accuracy and timely processing in a structured environment. The position requires strong communication skills, the ability to navigate multiple systems, and a focus on producing quality results.