Remote Claims Processor | Adjudication & Billing

Highmark Health; California; À distance; USD 27 000 - 33 000; Plein temps

Résumé du poste

Highmark Inc. is seeking a claims processor to screen, review, evaluate online entry, correct errors, and perform quality control review and final adjudication of paper and electronic claims.

You will determine whether to return, deny, or pay claims following policies and procedures, while coordinating benefits and communicating with customers. The role requires attention to detail, strong numerical and analytical skills, and the ability to navigate multiple systems concurrently.

Qualifications

• Receives and processes claims and verifies data.
• Determines eligibility and final payment.
• Communicates with customers professionally.
• Maintains accurate records and timekeeping.
• Adheres to production and quality standards.

Responsabilités

• Enter and verify claims data.
• Review edits and determine eligibility.
• Escalate issues to supervision as appropriate.
• Meet production and quality standards.
• Perform other duties as assigned.

Connaissances

Communication

Systems navigation

Administrative procedures

Mathematics for claims

Problem solving

Claims processing systems

Benefits interpretation

Data review

Formation

High School Diploma/GED

Description du poste

Highmark Inc. is seeking a claims processor to screen, review, evaluate online entry, correct errors, and perform quality control review and final adjudication of paper and electronic claims.

You will determine whether to return, deny, or pay claims following policies and procedures, while coordinating benefits and communicating with customers. The role requires attention to detail, strong numerical and analytical skills, and the ability to navigate multiple systems concurrently.