Remote Claims Specialist - Adjudication & QA

Highmark Health; New Jersey; Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine pay or denial decisions, correct errors, and ensure timely processing while coordinating with customers and internal teams.

The role emphasizes accurate data entry, verification, and adherence to policies, with remote work options and compliance with HIPAA and privacy policies.

Qualifications

• High School Diploma or GED required.
• 1 year of claims billing or processing experience preferred.

Responsibilities

• Receives and processes claims data, verifies completeness and accuracy.
• Determines eligibility and final payment based on policy and processing rules.

Skills

Strong communication

Multi-system navigation

Clerical procedures

Mathematics for adjudication

Data review and analysis

Claims processing knowledge

Attention to detail

Research and resolution

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a Claims Processor to screen, review, and adjudicate online and paper/electronic claims. You will determine pay or denial decisions, correct errors, and ensure timely processing while coordinating with customers and internal teams.

The role emphasizes accurate data entry, verification, and adherence to policies, with remote work options and compliance with HIPAA and privacy policies.