Remote Claims Adjudicator

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

Job summary

Highmark Inc. is seeking a claims processor to screen, review, evaluate online entry, correct errors and perform quality control review and final adjudication of paper/electronic claims. You will determine whether to return, deny or pay claims and coordinate benefits as needed in a remote setting.

The role requires strong communication, multi-system navigation, and adherence to HIPAA and privacy policies. Prior claim billing experience is preferred; Highmark emphasizes timely, accurate

Qualifications

• High School Diploma/GED is required.
• 1 year 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 maintains professional communication with internal and external customers.
• Meets production and quality standards and maintains accurate records, timekeeping, and training participation.
• Other duties as assigned or requested.

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a claims processor to screen, review, evaluate online entry, correct errors and perform quality control review and final adjudication of paper/electronic claims. You will determine whether to return, deny or pay claims and coordinate benefits as needed in a remote setting.

The role requires strong communication, multi-system navigation, and adherence to HIPAA and privacy policies. Prior claim billing experience is preferred; Highmark emphasizes timely, accurate