Remote Claims Adjudicator

Highmark Health; Central City (KY); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a claims processing professional to screen, review, and adjudicate online and paper claims, ensuring accurate, compliant, and timely payment decisions.

The role involves data entry, verifying claim completeness, and applying benefits rules to determine final payment. A focus on accurate records, communication with customers, and ongoing process improvement is essential.

Qualifications

• Requires HS diploma or GED.
• Preference given to candidates with 1 year of claim billing or processing experience.

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.

Skills

Communication

Multisystem navigation

Administration

Math for claims

Problem solving

Claims processing OS

Data review

Benefits review

Research and finalization

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a claims processing professional to screen, review, and adjudicate online and paper claims, ensuring accurate, compliant, and timely payment decisions.

The role involves data entry, verifying claim completeness, and applying benefits rules to determine final payment. A focus on accurate records, communication with customers, and ongoing process improvement is essential.