Remote Claims Adjudication Specialist

Highmark Health; Washington (District of Columbia); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Health is seeking an experienced claims processor to screen, review, and adjudicate online and paper/electronic claims. This role determines pay, deny, or return actions following policies and coordinates benefits, researching inquiries and providing technical assistance to resolve issues.

The position emphasizes timely, accurate claims adjustments and interactions with members and providers, with remote work options and compliance with HIPAA and privacy guidelines.

Qualifications

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

Responsibilities

• Receives and processes claims, enters/verifies data, and checks for completeness.
• Reviews edits and determines benefit eligibility and final payment.
• Escalates issues to supervisors and maintains professional communication with customers.
• Meets production and quality standards, maintains records, and attends trainings.
• Performs other duties as assigned or requested.

Skills

Attention to detail

Communication skills

Multitasking

Analytical thinking

Teamwork

Claims processing proficiency

Education

High School Diploma/GED

Tools

Claims processing software

Job description

Highmark Health is seeking an experienced claims processor to screen, review, and adjudicate online and paper/electronic claims. This role determines pay, deny, or return actions following policies and coordinates benefits, researching inquiries and providing technical assistance to resolve issues.

The position emphasizes timely, accurate claims adjustments and interactions with members and providers, with remote work options and compliance with HIPAA and privacy guidelines.