Remote Claims Adjudicator

Highmark Health; West Virginia; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processor for a remote position. The role involves screening, reviewing, evaluating online entry, correcting errors, and performing quality control to adjudicate paper and electronic claims. You will determine eligibility and final payment following policy guidelines while coordinating with customers.

The position requires attention to detail, strong communication skills, and the ability to navigate multiple systems. Prior claims experience is preferred.

Qualifications

• High School Diploma/GED is required.
• Preferred: 1 year claim billing or processing experience.

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 a professional line of communication 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

Claim processing

Quality control

Data entry

Customer communication

Problem solving

HIPAA knowledge

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Processor for a remote position. The role involves screening, reviewing, evaluating online entry, correcting errors, and performing quality control to adjudicate paper and electronic claims. You will determine eligibility and final payment following policy guidelines while coordinating with customers.

The position requires attention to detail, strong communication skills, and the ability to navigate multiple systems. Prior claims experience is preferred.