Remote Claims Adjudicator

Highmark Health; Honolulu (HI); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processor to screen, review, and adjudicate online and paper claims, ensuring accuracy and adherence to policies.

You will correct errors, perform QC reviews, and take steps to finalize adjudications while coordinating with members and providers as needed. The role requires strong communication, data entry, and analytical skills, with the ability to navigate multiple systems.

Qualifications

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Excellent verbal and written communication skills.

Responsibilities

• Receives and processes claims data; verifies completeness and accuracy.
• Resolves edits and determines benefit eligibility to reach final payment.
• Elevates issues to supervision and maintains professional communication with customers.
• Meets production and quality standards and maintains records including timekeeping.
• Other duties as assigned or requested.

Skills

Strong communication

Multi-system navigation

Claims adjudication

Analytical skills

Time management

Problem solving

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Processor to screen, review, and adjudicate online and paper claims, ensuring accuracy and adherence to policies.

You will correct errors, perform QC reviews, and take steps to finalize adjudications while coordinating with members and providers as needed. The role requires strong communication, data entry, and analytical skills, with the ability to navigate multiple systems.