Remote Claims Adjudicator

Highmark Health; Town of King (WI); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will verify data, determine eligibility, and decide on denial or payment following policy and procedures.

Collaboration with customers and internal teams is required to ensure timely and accurate claim actions. The role emphasizes adherence to HIPAA, data accuracy, and quality standards, with responsibilities ranging from data entry to final adjudication and reporting.

Qualifications

• High School Diploma or GED required.
• Experience with claims billing or processing preferred.

Responsibilities

• Receives and processes claims, verifies data for completeness and correctness.
• Determines benefit eligibility and final payment determinations.
• Escalates issues to supervision and maintains professional communication with customers.
• Meets production and quality standards, maintains records and attends required training.
• Performs other duties as assigned.

Skills

Verbal communication

Written communication

Multi-system navigation

Claims adjudication

Data analysis

Microsoft Office

HIPAA compliance

Education

High School Diploma/GED

Tools

Claim processing systems

Job description

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will verify data, determine eligibility, and decide on denial or payment following policy and procedures.

Collaboration with customers and internal teams is required to ensure timely and accurate claim actions. The role emphasizes adherence to HIPAA, data accuracy, and quality standards, with responsibilities ranging from data entry to final adjudication and reporting.