Remote Claims Adjudicator

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

Job summary

Highmark Inc. is seeking a Claims Specialist to screen, review, and adjudicate recorded claims. You will enter data, correct errors, and determine eligibility following established policies and procedures.

The role involves coordinating benefits, interacting with customers, and ensuring timely, accurate claim adjustments. Essential duties include processing claims, resolving edits, and maintaining records while meeting production standards.

Qualifications

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

Responsibilities

• Receives and processes claims data; ensures information is complete and correct.
• Resolves claim edits and determines benefit eligibility for service; reviews payment levels to determine final payment.
• Elevates issues to supervisor and maintains professional communication with customers.
• Meets production and quality standards; maintains accurate records and timekeeping; attends required trainings.
• Other duties as assigned or requested.

Skills

Communication

System navigation

Administration

Mathematics

Problem solving

Claims processing

Data review

Claims adj/denial

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Specialist to screen, review, and adjudicate recorded claims. You will enter data, correct errors, and determine eligibility following established policies and procedures.

The role involves coordinating benefits, interacting with customers, and ensuring timely, accurate claim adjustments. Essential duties include processing claims, resolving edits, and maintaining records while meeting production standards.