Remote Claims Adjudicator

Highmark Health; Trenton (NJ); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. in New Jersey seeks a claims processing professional to screen, review, and adjudicate claims accurately according to policy. You will verify data, correct errors, and determine pay/deny decisions while handling inquiries with professionalism.

Responsibilities include processing claims, resolving edits, ensuring timely production standards, and maintaining records. Remote work is available; strong numerical and communication skills are essential.

Qualifications

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

Responsibilities

• 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.

Skills

Communication skills

Multi-system navigation

Administrative procedures

Claims processing systems

Data analysis

Claims adjudication

Problem solving

Education

High School Diploma/GED

Job description

Highmark Inc. in New Jersey seeks a claims processing professional to screen, review, and adjudicate claims accurately according to policy. You will verify data, correct errors, and determine pay/deny decisions while handling inquiries with professionalism.

Responsibilities include processing claims, resolving edits, ensuring timely production standards, and maintaining records. Remote work is available; strong numerical and communication skills are essential.