Remote Claims Adjudicator

Highmark Health; Dover (DE); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processor to screen and review insurance claims, determine eligibility, and adjudicate payments. The role requires careful data entry, error correction, and timely action to support member and provider inquiries.

The successful candidate will navigate multiple claim processing systems, apply standard policies, and maintain accurate records while meeting production goals and quality standards. Remote position with US coverage.

Qualifications

• High School Diploma or GED required.
• Experience in claim billing or processing preferred.
• Strong written and verbal communication skills.

Responsibilities

• Screen and review claims for completeness and accuracy.
• Determine benefit eligibility and payment levels.
• Edit and adjust claims as needed; coordinate with customers.
• Maintain accurate records and meet production standards.
• Respond to inquiries and escalate issues appropriately.

Skills

Communication skills

Multi-system navigation

Analytical thinking

Mathematics for adjudication

Attention to detail

Customer service

Education

High School Diploma

Tools

Claims processing software

Job description

Highmark Inc. is seeking a Claims Processor to screen and review insurance claims, determine eligibility, and adjudicate payments. The role requires careful data entry, error correction, and timely action to support member and provider inquiries.

The successful candidate will navigate multiple claim processing systems, apply standard policies, and maintain accurate records while meeting production goals and quality standards. Remote position with US coverage.