Remote Claims Adjudication Specialist

Highmark Health; Rhode Island; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote Claims Processor responsible for screening, reviewing, and adjudicating online and paper claims. You will correct errors and ensure services follow policy, communicating effectively with members and providers.

The role emphasizes timely, accurate adjustments and audit-driven quality control in a distributed environment. The position requires high school diploma, with preference for 1 year of claims experience and strong multitasking across multiple systems.

Qualifications

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Strong communication and ability to navigate multiple systems.

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 and maintains professional communication with customers.
• Meets production and quality standards and maintains accurate records and timekeeping.

Skills

Verbal communication

Written communication

Attention to detail

Multisystem navigation

Problem solving

Claims processing knowledge

Time management

Data entry

Education

High School Diploma/GED

Tools

Claims processing software

Job description

Highmark Inc. is seeking a remote Claims Processor responsible for screening, reviewing, and adjudicating online and paper claims. You will correct errors and ensure services follow policy, communicating effectively with members and providers.

The role emphasizes timely, accurate adjustments and audit-driven quality control in a distributed environment. The position requires high school diploma, with preference for 1 year of claims experience and strong multitasking across multiple systems.