Remote Claims Processor - Detail-Oriented Adjudicator

Highmark Health; Arkansas City (KS); A distancia; USD 27.000 - 33.000; Jornada completa

Descripción de la vacante

Highmark Inc. is seeking a Claims Processor to screen, review, evaluate, and adjudicate online entry and paper claims, correcting errors and determining pay/deny outcomes per policy. You will process adjustments, respond to inquiries, and support audits while maintaining professional communication with members, providers, and internal teams.

A High School Diploma/GED is required; prior claim billing or processing experience is preferred. This is a remote position.

Formación

• Must have High School Diploma/GED.
• 1 year claim billing or processing experience preferred.

Responsabilidades

• 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.

Conocimientos

Verbal and written communication

Multi-system navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Claims processing OS knowledge

Data review and analysis

Reading benefits and edits

Claims research and finalization

Educación

High School Diploma/GED

Descripción del empleo

Highmark Inc. is seeking a Claims Processor to screen, review, evaluate, and adjudicate online entry and paper claims, correcting errors and determining pay/deny outcomes per policy. You will process adjustments, respond to inquiries, and support audits while maintaining professional communication with members, providers, and internal teams.

A High School Diploma/GED is required; prior claim billing or processing experience is preferred. This is a remote position.