Remote Claims Processor — Accurate Adjudication & Support

Highmark Health; Boise (ID); À distance; USD 27 000 - 33 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a claims processor responsible for screening, reviewing, evaluating online entry, correcting errors and adjudicating paper/electronic claims following organizational policies.

You will determine whether to return, deny or pay claims and perform related actions using enrollment, benefit and historical claim data. The role emphasizes timely processing, accuracy, and adherence to HIPAA and privacy policies.

Qualifications

• High School Diploma or GED required.
• 1 year claim billing or processing experience preferred.
• Strong verbal and written communication skills.
• Ability to navigate multiple systems.

Responsabilités

• Receives and processes claims data entry and verification.
• Determines claim completeness and correctness.
• Reviews edits and determines benefit eligibility and final payment.
• Maintains professional communication with internal and external customers.
• Meets production and quality standards; maintains records and training.

Connaissances

Strong verbal and written comms

Navigate multiple systems

Math to adjudicate claims

Problem solving within guidelines

Reading benefits and data

Formation

High School Diploma/GED

Description du poste

Highmark Inc. is seeking a claims processor responsible for screening, reviewing, evaluating online entry, correcting errors and adjudicating paper/electronic claims following organizational policies.

You will determine whether to return, deny or pay claims and perform related actions using enrollment, benefit and historical claim data. The role emphasizes timely processing, accuracy, and adherence to HIPAA and privacy policies.