Remote Claims Adjudication Specialist

Highmark Health; Salt Lake City (UT); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. in Salt Lake City is seeking a Claims Processor to screen, review, and adjudicate online and paper claims, ensuring accuracy and compliance with policy. You will verify data, resolve edits, and determine eligibility for payment.

The role emphasizes attention to detail, strong communication, and the ability to navigate multiple systems. Remote work is supported, with performance standards and ongoing training.

Qualifications

• High School Diploma or GED required.
• Experience in claims billing or processing preferred (1 year).
• Ability to follow policy and procedural guidelines.

Responsibilities

• Receives and processes claims data entries and verifications.
• Determines completeness and correctness of claim information.
• Resolves edits and determines benefit eligibility for service.
• Reviews payment levels to reach final payment determination.
• Maintains professional communication with customers and escalation as needed.

Skills

Verbal and written communication

Navigate multiple systems

Data review and analysis

Problem solving within guidelines

Claims adjudication basics

Benefits interpretation

Education

High School Diploma/GED

Job description

Highmark Inc. in Salt Lake City is seeking a Claims Processor to screen, review, and adjudicate online and paper claims, ensuring accuracy and compliance with policy. You will verify data, resolve edits, and determine eligibility for payment.

The role emphasizes attention to detail, strong communication, and the ability to navigate multiple systems. Remote work is supported, with performance standards and ongoing training.