Remote Claims Adjudication Specialist

Highmark Health; South Dakota; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a claims processing specialist to screen, review, and adjudicate online and paper claims. You will verify data, determine eligibility, and take corrective actions while coordinating with members and providers.

This remote role emphasizes accuracy, customer service, and adherence to policy. Responsibilities include processing claims, resolving edits, and maintaining records. Strong communication and data-entry skills are essential, with expectations for meeting production

Qualifications

• High School Diploma/GED required.
• Attention to detail and accuracy in data entry and claim processing.
• Strong communication skills, both written and verbal.
• Ability to navigate multiple systems and maintain confidentiality.

Responsibilities

• Enter and verify claims data; ensure information is complete and correct.
• Resolve claim edits and determine benefit eligibility and payment levels.
• Escalate issues appropriately and maintain professional communication with customers.
• Meet production and quality standards, maintain accurate records, and participate in required training.
• Perform additional duties as assigned.

Job description

Highmark Inc. is seeking a claims processing specialist to screen, review, and adjudicate online and paper claims. You will verify data, determine eligibility, and take corrective actions while coordinating with members and providers.

This remote role emphasizes accuracy, customer service, and adherence to policy. Responsibilities include processing claims, resolving edits, and maintaining records. Strong communication and data-entry skills are essential, with expectations for meeting production