Remote Claims Adjudicator: Ensure Timely, Accurate Payments

Highmark Health; Augusta (ME); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Adjudicator to screen, review, and adjudicate paper and electronic claims in a remote capacity. You will verify claim data, determine eligibility, and finalize payments according to policies, while coordinating with customers as needed.

Responsibilities include resolving edits, ensuring accuracy and timeliness, maintaining records, and escalating issues to supervision as appropriate. A High School Diploma or GED and claims processing experience are preferred.

Qualifications

• High School Diploma or GED.
• One year of claim billing or processing experience.

Responsibilities

• Process and verify claims data for completeness and correctness.
• Determine benefit eligibility and final payment levels.
• Escalate issues appropriately and maintain professional communication.
• Meet production and quality standards; maintain records and timekeeping.
• Perform other duties as requested.

Skills

Strong communication

Multi-system navigation

Admin procedures

Math for adjudication

Problem solving

Claims processing OS

Claims data review

Benefits interpretation

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Adjudicator to screen, review, and adjudicate paper and electronic claims in a remote capacity. You will verify claim data, determine eligibility, and finalize payments according to policies, while coordinating with customers as needed.

Responsibilities include resolving edits, ensuring accuracy and timeliness, maintaining records, and escalating issues to supervision as appropriate. A High School Diploma or GED and claims processing experience are preferred.