Remote Claims Specialist – Adjudication & Quality

Highmark Health; Elm (PA); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. is seeking a remote claims processor responsible for screening and adjudicating online and paper/electronic claims. You will review, correct, and finalize claims according to policies, coordinate benefits, and interact with customers to ensure timely processing.

The role requires high school graduation and may prefer 1 year of billing/processing experience. Strong communication and data analysis skills are essential for accurate adjudication.

Qualifications

• High School Diploma or GED is required.
• Preferred 1 year of claims billing or processing experience.
• Strong communication and ability to navigate multiple systems.

Responsibilities

• Receives and processes claims data entry and verification.
• Determines claim completeness and correctness.
• Reviews edits and determines benefit eligibility and payment levels.
• Maintains professional communication with customers and team.
• Performs other duties as assigned.

Skills

Strong communication

Multi-system navigation

Administrative procedures

Mathematics for claims

Problem solving

Claims data analysis

Claims review

Research and finalizing claims

Education

High School Diploma/GED

Job description

Highmark Inc. is seeking a remote claims processor responsible for screening and adjudicating online and paper/electronic claims. You will review, correct, and finalize claims according to policies, coordinate benefits, and interact with customers to ensure timely processing.

The role requires high school graduation and may prefer 1 year of billing/processing experience. Strong communication and data analysis skills are essential for accurate adjudication.