Remote Claims Processor – Accurate Adjudication & Support

Highmark Health; Denver (CO); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Adjudicator to screen, review, and finalize claims with accuracy. You will correct errors, adjudicate benefits, and coordinate with customers as needed while supporting adherence to HIPAA and internal policies.

The role emphasizes attention to detail, data accuracy, and the ability to navigate multiple systems to determine eligibility and payment levels. Remote work is offered.

Qualifications

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

Responsibilities

• Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct.
• Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment levels to arrive at final payment determination.
• Elevates issues to next level of supervision as appropriate and ensures a professional line of communication is maintained with internal and external customers.
• Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records, including timekeeping records and attends all required training classes.
• Other duties as assigned or requested.

Skills

Communication skills

Multi-system navigation

Administrative procedures

Mathematics for claims

Problem solving

Claim processing OS

Data analysis

Claims research

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Adjudicator to screen, review, and finalize claims with accuracy. You will correct errors, adjudicate benefits, and coordinate with customers as needed while supporting adherence to HIPAA and internal policies.

The role emphasizes attention to detail, data accuracy, and the ability to navigate multiple systems to determine eligibility and payment levels. Remote work is offered.