Remote Claims Adjudicator

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

Job summary

Highmark Health is seeking a claims processor to screen, review, and adjudicate online and paper claims. This role involves correcting errors, determining whether to pay, deny, or return claims, following organizational policies and procedures.

You will work with enrollment, benefits, and historical claim data, providing technical assistance in researching inquiries and supporting timely claim adjustments due to audits, member or provider inquiries, and system changes.

Qualifications

• High School Diploma/GED required.
• 1 year claim billing or processing experience preferred.

Responsibilities

• Process and enter/verify claims data and determine if claim information is complete and correct.
• Resolve claim edits, review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination.
• Elevate issues to next level of supervision as appropriate and maintain professional communication with internal and external customers.
• Meet all production and quality standards, maintain accurate records, including timekeeping and attend required training classes.
• Other duties as assigned or requested.

Skills

Communication

Multi-system navigation

Administration & records

Claim adjudication math

Problem solving

Claim processing systems

Benefits review

Data research

Education

High School Diploma/GED

Job description

Highmark Health is seeking a claims processor to screen, review, and adjudicate online and paper claims. This role involves correcting errors, determining whether to pay, deny, or return claims, following organizational policies and procedures.

You will work with enrollment, benefits, and historical claim data, providing technical assistance in researching inquiries and supporting timely claim adjustments due to audits, member or provider inquiries, and system changes.