Remote Claims Processor - Adjudication & Payments

Highmark Health; Pierre (SD); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processor to screen, review, and adjudicate paper and electronic claims. The role emphasizes accuracy, timely processing, and adherence to policies while handling inquiries and adjustments.

You will verify data, resolve edits, determine eligibility, and communicate findings to customers. Prior billing or processing experience is preferred; HS diploma required, with a focus on quality and regulatory compliance.

Qualifications

• High school diploma or GED required.
• Experience with claim billing or processing 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

System navigation

Administrative procedures

Math for claims

Problem solving

Data analysis

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Processor to screen, review, and adjudicate paper and electronic claims. The role emphasizes accuracy, timely processing, and adherence to policies while handling inquiries and adjustments.

You will verify data, resolve edits, determine eligibility, and communicate findings to customers. Prior billing or processing experience is preferred; HS diploma required, with a focus on quality and regulatory compliance.