Remote Claims Adjudication Specialist

Highmark; United States; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a dedicated Claims Processor to screen, review, and adjudicate electronic and paper claims remotely.

You will verify data, determine eligibility, and apply corrections as needed while maintaining compliance with HIPAA and internal policies. The role requires strong attention to detail, excellent written and verbal communication, and the ability to navigate multiple claim processing systems.

Qualifications

• Strong verbal and written communication skills.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to use mathematics to adjudicate claims.
• Ability to solve problems within pre-defined methods and guidelines.
• Knowledge of operating systems specific to claim processing.
• Ability to review claims and analyze critical data.
• Reading benefits, investigating edits and making benefit determinations as required in adjusting and adjudicating most types of claims.
• Researches and finalizes claims, adjustments, inquiries and reports as required.

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 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.

Skills

Communication skills

Systems navigation

Admin procedures

Claims math

Problem solving

Claim processing OS

Data analysis

Benefit determinations

Claims research

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a dedicated Claims Processor to screen, review, and adjudicate electronic and paper claims remotely.

You will verify data, determine eligibility, and apply corrections as needed while maintaining compliance with HIPAA and internal policies. The role requires strong attention to detail, excellent written and verbal communication, and the ability to navigate multiple claim processing systems.