Remote Claims Adjudication Specialist

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

Job summary

Highmark Inc. is seeking a claims processing professional to review and adjudicate online entries and corrections. You will ensure accuracy, determine final payment determinations, and liaise with customers while maintaining HIPAA compliance and high-quality standards.

The role emphasizes timely processing, data integrity, and collaboration with supervisors to resolve issues and respond to inquiries in a remote setting.

Qualifications

• High School Diploma or GED required.
• One year claim billing or processing experience preferred.
• Ability to navigate multiple systems and verify data.
• Strong communication and problem-solving skills.

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.
• Other duties as assigned or requested.

Job description

Highmark Inc. is seeking a claims processing professional to review and adjudicate online entries and corrections. You will ensure accuracy, determine final payment determinations, and liaise with customers while maintaining HIPAA compliance and high-quality standards.

The role emphasizes timely processing, data integrity, and collaboration with supervisors to resolve issues and respond to inquiries in a remote setting.