Remote Claims Adjudication Specialist

Highmark Health Company; Pennsylvania; Hybrid; USD 27,000 - 33,000; Full time

Job summary

Highmark Health in the United States is seeking a Claims Processor responsible for screening, reviewing, and adjudicating online and paper/electronic claims. You will determine pay/deny decisions, correct errors, and research inquiries while ensuring timely processing and quality standards.

The role involves working with enrollment, benefits, and historical data to resolve claims, with a focus on accuracy and customer communication.

Qualifications

• High School Diploma or GED is required.
• Preferred 1 year claim billing or processing experience.
• Ability to navigate multiple systems simultaneously.
• Knowledge of administration and clerical procedures.

Responsibilities

• Receives and processes claims data; verifies completeness and correctness.
• Resolves claim edits and determines benefit eligibility.
• Reviews payment levels to determine final payment.
• Escalates issues to supervision while maintaining professional communication.
• Meets production and quality standards; keeps accurate records.
• Performs other duties as assigned.

Skills

Verbal communication

Written communication

Multitasking

Attention to detail

Problem solving

Claims processing knowledge

Education

High School Diploma or GED

Job description

Highmark Health in the United States is seeking a Claims Processor responsible for screening, reviewing, and adjudicating online and paper/electronic claims. You will determine pay/deny decisions, correct errors, and research inquiries while ensuring timely processing and quality standards.

The role involves working with enrollment, benefits, and historical data to resolve claims, with a focus on accuracy and customer communication.