Remote Claims Adjudication Specialist

Highmark Health; Oregon; Hybrid; USD 27.000 - 33.000; Vollzeit

Zusammenfassung

Highmark Inc. is seeking a remote claims processor to screen, review, and adjudicate online and paper claims. You will verify data, correct errors, and determine pay or denial following policy. The role requires attention to detail and precise math to finalize claim outcomes.

Responsibilities include processing claims, reconciling edits, and maintaining records while meeting quality standards and deadlines in a HIPAA-compliant environment.

Qualifikationen

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Strong communication skills (verbal and written).

Aufgaben

• Receives and processes claims data to ensure completeness and correctness.
• Resolves edits and determines benefit eligibility and payment levels.
• Escalates issues to supervision and maintains professional communication with customers.
• Meets production and quality standards, keeps accurate time and training records.
• Performs other duties as assigned.

Kenntnisse

Verbal communication

Written communication

Attention to detail

Multi-system navigation

Mathematical adjudication

Problem solving

Ausbildung

High School Diploma/GED

Jobbeschreibung

Highmark Inc. is seeking a remote claims processor to screen, review, and adjudicate online and paper claims. You will verify data, correct errors, and determine pay or denial following policy. The role requires attention to detail and precise math to finalize claim outcomes.

Responsibilities include processing claims, reconciling edits, and maintaining records while meeting quality standards and deadlines in a HIPAA-compliant environment.