Remote Claims Processor: Fast, Accurate Adjudication

Highmark Health; Topeka (KS); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. in Topeka, Kansas, is seeking a remote Claims Processor who will screen, review, and adjudicate online and paper/electronic claims.

You will determine whether to return, deny, or pay claims following policies and procedures, coordinate benefits, and provide technical assistance in inquiries. The role requires attention to detail, strong communication, and the ability to work across multiple systems to ensure timely, accurate claims adjustments and compliance with HIPAA and company

Qualifications

• Strong verbal and written communication skills.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to use mathematics to adjudicate claims.
• Ability to solve problems within pre-defined methods and guidelines.
• Knowledge of operating systems specific to claim processing.
• Ability to review claims and analyze critical data.
• Researches and finalizes claims, adjustments, inquiries and reports as required.

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

Strong communication

Multi-system navigation

Administrative procedures

Mathematics for adjudication

Problem solving

Claims processing systems

Data review and interpretation

Education

High School Diploma/GED

Tools

Claim processing software

Job description

Highmark Inc. in Topeka, Kansas, is seeking a remote Claims Processor who will screen, review, and adjudicate online and paper/electronic claims.

You will determine whether to return, deny, or pay claims following policies and procedures, coordinate benefits, and provide technical assistance in inquiries. The role requires attention to detail, strong communication, and the ability to work across multiple systems to ensure timely, accurate claims adjustments and compliance with HIPAA and company