Remote Claims Adjudication Specialist

Highmark Health; Santa Fe (NM); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processor to screen, review, evaluate online entry, correct errors and perform quality control and final adjudication of paper/electronic claims.

This role determines whether to return, deny or pay claims following organizational policies and procedures, and coordinates benefits for customers. The position requires attention to detail, strong problem-solving abilities, and the ability to navigate multiple systems while communicating clearly with internal and

Qualifications

• Strong communication skills and ability to document issues clearly.
• Experience reviewing and correcting claim data per policies.
• Familiar with claim processing systems and HIPAA requirements.

Responsibilities

• Receives and processes claims, entering and verifying data.
• Determines if claim information is complete and correct.
• Resolves claim edits and reviews history for eligibility.
• Assists in action steps and maintains professional communication with customers.
• Meets production and quality standards; maintains timekeeping records.

Skills

Strong verbal and writtencommunication

Navigate multiple systems

Administrative procedures

Mathematics for adjudication

Problem solving

Review claims data

Data accuracy

Claims processing knowledge

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Processor to screen, review, evaluate online entry, correct errors and perform quality control and final adjudication of paper/electronic claims.

This role determines whether to return, deny or pay claims following organizational policies and procedures, and coordinates benefits for customers. The position requires attention to detail, strong problem-solving abilities, and the ability to navigate multiple systems while communicating clearly with internal and