Remote Claims Adjudicator

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

Job summary

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online entries and corrections of paper/electronic claims.

You will determine whether to return, deny, or pay based on policies, using enrollment, benefits, and claim data, while coordinating with members and providers as needed. The role requires strong communication, attention to detail, and the ability to work across multiple systems to ensure timely and accurate claim adjustments.

Qualifications

• High School Diploma or GED required.
• Prior claim billing or processing experience preferred.
• Strong communication skills and ability to navigate multiple systems.

Responsibilities

• Receives and processes claims data entry and verification.
• Determines claim completeness and correctness.
• Reviews edits and determines benefit eligibility and final payment.
• Maintains professional communication with customers and internal teams.
• Extends timely production and quality in all tasks and records.

Skills

Strong communication

Multi-system navigation

Data entry accuracy

Math for adjudication

Problem solving

Claims processing knowledge

Reading benefits

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online entries and corrections of paper/electronic claims.

You will determine whether to return, deny, or pay based on policies, using enrollment, benefits, and claim data, while coordinating with members and providers as needed. The role requires strong communication, attention to detail, and the ability to work across multiple systems to ensure timely and accurate claim adjustments.