Remote Claims Specialist — Adjudication & Resolution

Allegheny Clinic; Pennsylvania; Híbrido; USD 27.000 - 33.000; Tempo integral

Resumo da vaga

Highmark Inc. is seeking a remote claims processor to screen, review, and adjudicate online and paper/electronic claims. You will determine pay/deny actions, study processing history, and coordinate with customers as needed, while ensuring timely quality review and edits.

The role requires a High School Diploma or GED and may involve handling audits, appeals, and system changes with attention to detail and strong communication skills.

Qualificações

• High School Diploma or GED required.
• Employer expects ability to interpret benefits and adjust claims per guidelines.
• Must be able to review and adjudicate claims accurately.

Responsabilidades

• Receives and processes claims data; verifies completeness and correctness.
• Resolves claim edits and determines benefit eligibility for service.
• Reviews payment levels to arrive at final payment determination.
• Escalates issues to supervision and maintains professional communication.
• Meets production and quality standards; maintains records and attends training.

Conhecimentos

Strong verbal and written comms

Take direction

Administrative procedures

Adjudicate claims math

Problem solving

Claims processing knowledge

Data review & analysis

Formação

High School Diploma/GED

Descrição da vaga

Highmark Inc. is seeking a remote claims processor to screen, review, and adjudicate online and paper/electronic claims. You will determine pay/deny actions, study processing history, and coordinate with customers as needed, while ensuring timely quality review and edits.

The role requires a High School Diploma or GED and may involve handling audits, appeals, and system changes with attention to detail and strong communication skills.