Remote Claims Adjudicator

Highmark Health; Texas; Remoto; USD 27.000 - 33.000; Tempo pieno

Descrizione del lavoro

Highmark Health is seeking a claims adjudication professional to screen, review, and finalize online and paper/electronic claims. You will determine eligibility, correct errors, and coordinate with customers to ensure accurate payments while adhering to HIPAA and internal policies.

This role emphasizes timely, high-quality processing across multiple systems. The position requires a High School Diploma or GED, with a preference for 1 year of claim billing or processing experience.

Competenze

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

Mansioni

• Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct.
• Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment levels to arrive at final payment determination.
• Elevates issues to next level of supervision as appropriate and ensures a professional line of communication is maintained with internal and external customers.
• Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records, including timekeeping records and attends all required training classes.
• Other duties as assigned or requested.

Conoscenze

Verbal communication

Written communication

Multi-system navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Formazione

High School Diploma/GED

Descrizione del lavoro

Highmark Health is seeking a claims adjudication professional to screen, review, and finalize online and paper/electronic claims. You will determine eligibility, correct errors, and coordinate with customers to ensure accurate payments while adhering to HIPAA and internal policies.

This role emphasizes timely, high-quality processing across multiple systems. The position requires a High School Diploma or GED, with a preference for 1 year of claim billing or processing experience.