Remote Claims Adjudication Specialist

Highmark Health; South Dakota Park (SD); A distancia; USD 27.000 - 33.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a claims processing specialist to screen, review, and adjudicate online and paper/electronic claims. The role involves determining eligibility, correcting errors, and resolving inquiries while adhering to organizational policies.

Responsibilities include processing claims data, reviewing edits, ensuring timely production standards, and maintaining accurate records. Remote work arrangement is available; candidate must meet HIPAA and privacy requirements.

Formación

• High School Diploma/GED required.
• 1 year claim billing or processing experience preferred.

Responsabilidades

• 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 ensures a professional line of communication is maintained with internal and external customers.
• Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records, including timekeeping records and attends all required training classes.
• Other duties as assigned or requested.

Conocimientos

Communication skills

Multisystem navigation

Administrative procedures

Math for adjudication

Problem solving

Claims processing systems

Data analysis

Benefit reading

Educación

High School Diploma/GED

Descripción del empleo

Highmark Inc. is seeking a claims processing specialist to screen, review, and adjudicate online and paper/electronic claims. The role involves determining eligibility, correcting errors, and resolving inquiries while adhering to organizational policies.

Responsibilities include processing claims data, reviewing edits, ensuring timely production standards, and maintaining accurate records. Remote work arrangement is available; candidate must meet HIPAA and privacy requirements.