Remote Claims Adjudicator

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

Job summary

Highmark Inc. in the United States is seeking a claims processing specialist responsible for screening, reviewing, and adjudicating online and paper claims, ensuring accuracy and timely resolution in line with policy.

You will verify data, determine eligibility, coordinate benefits, and provide technical assistance as needed, while maintaining clear communication with members and providers and meeting production and quality standards.

Qualifications

• High School Diploma or GED required.
• Preferred: 1 year claim billing or processing experience.
• Strong communication and problem-solving skills.

Responsibilities

• Process and verify claims data to determine accuracy.
• Determine benefit eligibility and final payment decisions.
• Coordinate with customers and maintain professional communication.
• Meet production and quality standards and keep records.
• Perform additional duties as assigned.

Skills

Verbal communication

Written communication

Multi-system navigation

Claims processing

Analytical reasoning

Education

High School Diploma/GED

Job description

Highmark Inc. in the United States is seeking a claims processing specialist responsible for screening, reviewing, and adjudicating online and paper claims, ensuring accuracy and timely resolution in line with policy.

You will verify data, determine eligibility, coordinate benefits, and provide technical assistance as needed, while maintaining clear communication with members and providers and meeting production and quality standards.