Remote Claims Adjudicator

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

Job summary

Highmark Inc. is seeking a claims processor for remote work focused on screening, reviewing, and adjudicating online and paper claims in compliance with policies.

The role emphasizes accuracy, timely processing, and customer interaction while applying enrollment and benefit rules. The position requires a high school diploma and preferably 1 year of claim billing or processing experience, with strong communication and problem-solving skills to navigate multiple systems and ensure proper claim

Qualifications

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

Responsibilities

• Receives and processes claims data to ensure information is complete and correct.
• Resolves claim edits and determines benefit eligibility and final payment.
• Elevates complex issues to supervision while maintaining professional communication with customers.
• Ensures production and quality standards are met and maintains accurate timekeeping and records.
• Performs other duties as assigned.

Skills

Strong communication

Attention to detail

Ability to navigate multiple systems

Mathematics for adjudication

Problem solving

Reading benefits and edits

Researching claims

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a claims processor for remote work focused on screening, reviewing, and adjudicating online and paper claims in compliance with policies.

The role emphasizes accuracy, timely processing, and customer interaction while applying enrollment and benefit rules. The position requires a high school diploma and preferably 1 year of claim billing or processing experience, with strong communication and problem-solving skills to navigate multiple systems and ensure proper claim