Remote Claims Processor: Accurate Adjudication

Highmark Health; Frankfort (KY); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine whether to return, deny, or pay based on policies, and perform quality control on processed claims. Role involves interaction with customers and coordination with multiple systems.

Requirements include a High School Diploma or GED, with a preference for 1 year of claim billing or processing experience. Strong communication and data accuracy are essential.

Qualifications

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

Responsibilities

• Receives and processes claims; enters and verifies data.
• Determines claim completeness and accuracy; sets final payment determinations.
• Resolves claim edits and reviews history to determine eligibility and payment.
• Maintains professional communication with customers and ensures timely processing.
• Follows compliance guidelines and participates in required training.

Skills

Communication

Multitasking

Attention to detail

Data entry

Numerical adjudication

Problem solving

System navigation

Benefits review

Education

High School Diploma/GED

Tools

Claim processing software

Job description

Highmark Inc. is seeking a remote Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine whether to return, deny, or pay based on policies, and perform quality control on processed claims. Role involves interaction with customers and coordination with multiple systems.

Requirements include a High School Diploma or GED, with a preference for 1 year of claim billing or processing experience. Strong communication and data accuracy are essential.