Remote Claims Processor: Accurate Adjudication & QA

Highmark Health; Columbus (OH); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a claims processor working remotely. The role involves screening, reviewing, and adjudicating claims, with focus on accuracy and timely processing. You will verify data, resolve edits, and determine benefit eligibility while maintaining clear communication with customers.

Requirements include a High School Diploma/GED and preferred experience in claim billing or processing. The position emphasizes adherence to policies and ability to work across multiple systems.

Qualifications

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

Responsibilities

• Receives and processes claims data entries and verifies completeness.
• Resolves edits and determines benefit eligibility and final payment.
• Escalates issues to supervision and maintains professional communication with customers.
• Meets production and quality standards; maintains accurate records and attends training.

Skills

Strong communication

Multisystem navigation

Administrative procedures

Mathematics in claims

Problem solving (pre-defined methods)

Claim processing

Operating systems for claims

Claims analysis

Reading benefits & edits

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a claims processor working remotely. The role involves screening, reviewing, and adjudicating claims, with focus on accuracy and timely processing. You will verify data, resolve edits, and determine benefit eligibility while maintaining clear communication with customers.

Requirements include a High School Diploma/GED and preferred experience in claim billing or processing. The position emphasizes adherence to policies and ability to work across multiple systems.