Remote Claims Adjudication Specialist

Highmark Health; Providence (RI); Remote; USD 27,000 - 33,000; Full time

Benefits offered by this job

Remote work

Job summary

Highmark Inc. is seeking a Claims Adjudication specialist to screen, review, and adjudicate online and paper claims. You will identify errors, correct entries, and perform quality control to ensure accurate payments or denials in alignment with policy.

The role requires a High School Diploma or GED, with a preference for 1 year of claims processing experience. Remote work option available with strict compliance to HIPAA policies.

Qualifications

• High school diploma or GED required.
• 1 year of claim billing or processing experience preferred.
• Strong verbal and written communication skills.
• Ability to navigate multiple systems and input data accurately.
• Knowledge of claims processing guidelines and policies.

Responsibilities

• Screen, review, and adjudicate online and paper claims to determine return, denial, or payment.
• Correct errors and perform quality control reviews.
• Coordinate with internal/external stakeholders to resolve inquiries and discrepancies.
• Maintain accurate records and timekeeping; meet production and quality standards.
• Comply with HIPAA and company privacy and security policies.

Skills

Claims processing

Attention to detail

Communication skills

Multi-system navigation

Problem solving

HIPAA knowledge

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Adjudication specialist to screen, review, and adjudicate online and paper claims. You will identify errors, correct entries, and perform quality control to ensure accurate payments or denials in alignment with policy.

The role requires a High School Diploma or GED, with a preference for 1 year of claims processing experience. Remote work option available with strict compliance to HIPAA policies.