Remote Claims Adjudication Specialist

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

Job summary

Highmark Inc. is seeking a claims processor responsible for screening, reviewing, and adjudicating online and paper/electronic claims in accordance with company policies.

You will verify data, determine eligibility, correct errors, and communicate with customers while meeting production and quality standards. This remote role offers a pay range and requires a HS diploma; prior claim billing experience is preferred.

Qualifications

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

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

Multi-system navigation

Administrative procedures

Math for claims

Problem solving

Claims processing systems

Data analysis

Benefits review

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a claims processor responsible for screening, reviewing, and adjudicating online and paper/electronic claims in accordance with company policies.

You will verify data, determine eligibility, correct errors, and communicate with customers while meeting production and quality standards. This remote role offers a pay range and requires a HS diploma; prior claim billing experience is preferred.