Remote Claims Adjudicator

Highmark Health; Provo (UT); 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/electronic claims. You will correct errors, review inquiries, and determine to return, deny, or pay claims following internal policies and procedures.

The role involves coordinating benefits, interacting with customers, and ensuring timely and accurate adjustments. The position emphasizes HIPAA compliance, data accuracy, and adherence to established procedures.

Qualifications

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Ability to analyze claims and determine eligibility.

Responsibilities

• Receives and processes claims; enters/verifies data.
• Determines if claim information is complete and correct.
• Resolves edits and determines benefit eligibility for service.
• Elevates issues to supervision as appropriate and maintains professional communication with customers.
• Meets production and quality standards and maintains records including timekeeping and training.
• Other duties as assigned or requested.

Skills

Communication

Multisystem navigation

Data entry

Numerical adjudication

Problem solving

Education

High School Diploma or GED

Job description

Highmark Inc. is seeking a claims processor to screen, review, and adjudicate online and paper/electronic claims. You will correct errors, review inquiries, and determine to return, deny, or pay claims following internal policies and procedures.

The role involves coordinating benefits, interacting with customers, and ensuring timely and accurate adjustments. The position emphasizes HIPAA compliance, data accuracy, and adherence to established procedures.