Remote Claims Processor - Fast Adjudication & Resolution

Highmark Health; Kentucky; Remoto; USD 27.000 - 33.000; Tempo pieno

Descrizione del lavoro

Highmark Inc. is seeking a Claims Processor responsible for screening, reviewing, evaluating online entry, correcting errors and final adjudication of paper/electronic claims.

You determine whether to return, deny or pay claims following policies and procedures and may coordinate benefits with enrollment data while interacting with customers. Remote role emphasizing timely and accurate processing, maintaining records, and meeting quality standards.

Competenze

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

Mansioni

• 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 maintains communication with customers.
• Meets production and quality standards and maintains accurate records.

Conoscenze

Verbal and written communication

Navigate multiple systems

Administrative procedures

Mathematics for adjudication

Problem solving

Claim processing systems

Data review and analysis

Benefits reading and determination

Formazione

High School Diploma/GED

Descrizione del lavoro

Highmark Inc. is seeking a Claims Processor responsible for screening, reviewing, evaluating online entry, correcting errors and final adjudication of paper/electronic claims.

You determine whether to return, deny or pay claims following policies and procedures and may coordinate benefits with enrollment data while interacting with customers. Remote role emphasizing timely and accurate processing, maintaining records, and meeting quality standards.