Remote Claims Adjudication Specialist

Highmark Health; Sacramento (CA); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Reviewer to screen, review, correct errors, and adjudicate both online and paper claims following policy. You will determine pay/deny decisions, adjust as needed, and support inquiries from members and providers.

This remote role requires a High School Diploma or GED, strong written and verbal communication, math skills for adjudication, and the ability to navigate multiple claims systems.

Qualifications

• Strong verbal and written communication skills.
• Ability to navigate multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and systems.
• Ability to use mathematics to adjudicate claims.
• Ability to solve problems within pre-defined methods and guidelines.
• Knowledge of operating systems specific to claim processing.
• Ability to review claims and analyze critical data.
• Reading benefits, investigating edits and making benefit determinations.

Responsibilities

• Receives and processes claims, verifies data accuracy.
• Determines if claim information is complete and correct.
• Reviews edits and determines benefit eligibility for service.
• Communicates with customers and supervisors as needed.
• Maintains records and attends required training.

Skills

Communication

Multi-system navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Claim processing systems

Data analysis

Benefits interpretation

Claims research

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Reviewer to screen, review, correct errors, and adjudicate both online and paper claims following policy. You will determine pay/deny decisions, adjust as needed, and support inquiries from members and providers.

This remote role requires a High School Diploma or GED, strong written and verbal communication, math skills for adjudication, and the ability to navigate multiple claims systems.