Remote Claims Adjudication Specialist

Highmark Health; Philadelphia (Philadelphia County); A distancia; USD 27.000 - 33.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a Claims Processor responsible for screening and adjudicating online and paper claims, correcting errors, and performing quality control reviews.

The role analyzes enrollment, benefits, and historical data to determine pay actions and coordinates with customers as needed. The candidate will enter and verify data, resolve edits, review benefit eligibility, and ensure timely processing.

Formación

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

Responsabilidades

• 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.

Conocimientos

Communication

Multi-system navigation

Administrative procedures

Math for adjudication

Problem solving

Claims processing software

Data analysis

Reading benefits

Educación

High School Diploma/GED

Descripción del empleo

Highmark Inc. is seeking a Claims Processor responsible for screening and adjudicating online and paper claims, correcting errors, and performing quality control reviews.

The role analyzes enrollment, benefits, and historical data to determine pay actions and coordinates with customers as needed. The candidate will enter and verify data, resolve edits, review benefit eligibility, and ensure timely processing.