Remote Claims Adjudication Specialist

Highmark Health; Salem (OR); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking a claims processor to screen, review, and adjudicate online and paper/electronic claims. You will determine eligibility, correct errors, and coordinate benefits while maintaining timely, accurate records and providing strong customer communication.

The role emphasizes adherence to policies, thorough documentation, and efficient resolution of inquiries, with a focus on quality and production standards in a remote work setting.

Qualifications

• High School Diploma or GED required.
• Preferred: 1 year claim billing or processing experience.

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 as appropriate and maintains professional communication with customers.
• Meets all production and quality standards, maintains accurate records and attends required training classes.
• Other duties as assigned or requested.

Skills

Communication skills

Multi-system navigation

Administrative procedures

Claim adjudication

Problem solving

Data review

Claim processing systems

Education

High School Diploma/GED

Job description

Highmark Health is seeking a claims processor to screen, review, and adjudicate online and paper/electronic claims. You will determine eligibility, correct errors, and coordinate benefits while maintaining timely, accurate records and providing strong customer communication.

The role emphasizes adherence to policies, thorough documentation, and efficient resolution of inquiries, with a focus on quality and production standards in a remote work setting.