Remote Claims Adjudicator

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

Job summary

Highmark Inc. is seeking a claims adjudication specialist to screen and review online entry, correct errors, and perform quality control and final adjudication of paper/electronic claims. You will determine pay/deny decisions and coordinate benefits while interacting with customers. Strong communication and data accuracy are essential.

This remote role supports timely adjustments and requires attention to HIPAA compliance and company policies. Prior claims processing experience is preferred.

Qualifications

• Strong verbal and written communication skills.
• Ability to navigate multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and systems.
• Ability to use mathematics to adjudicate claims.
• Ability to solve problems within defined methods and guidelines.

Responsibilities

• Receives and processes claims, entering/verifying data and ensuring information is complete and correct.
• Resolves claim edits and determines benefit eligibility and final payment.
• Escalates issues to supervision while maintaining professional communication with customers.
• Meets production and quality standards, maintains records, including timekeeping and training.
• Other duties as assigned or requested.

Skills

Communication skills

Systems navigation

Administrative procedures

Math for claims

Problem solving

Claims processing OS

Data analysis

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a claims adjudication specialist to screen and review online entry, correct errors, and perform quality control and final adjudication of paper/electronic claims. You will determine pay/deny decisions and coordinate benefits while interacting with customers. Strong communication and data accuracy are essential.

This remote role supports timely adjustments and requires attention to HIPAA compliance and company policies. Prior claims processing experience is preferred.