Remote Claims Adjudicator

Highmark Health; Guin (AL); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will verify data, determine eligibility, and review payments while adhering to policies.

The role requires a High School Diploma/GED and 1 year of claim processing experience; strong communication and problem-solving skills are essential. Remote position with standard production expectations.

Qualifications

• High School Diploma or GED required.
• 1 year of claim billing or processing experience preferred.
• Experience with claims processing systems is a plus.

Responsibilities

• Receives and processes claims data to ensure completeness and correctness.
• Resolves claim edits and determines benefit eligibility and final payment.
• Escalates issues to supervision as needed and communicates professionally with customers.
• Maintains production and quality standards and accurate records.
• Performs other duties as assigned

Skills

Verbal & written comms

Multi-system navigation

Administrative procedures

Math for claims

Problem solving

Claims processing OS

Claims data review

Benefits adjudication

Research & finalization

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will verify data, determine eligibility, and review payments while adhering to policies.

The role requires a High School Diploma/GED and 1 year of claim processing experience; strong communication and problem-solving skills are essential. Remote position with standard production expectations.