Claims Processor

Job not on LinkedIn

🔥 17 hours ago

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $19 - $24 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Screen, review, evaluate online entries, correct errors, and perform quality control review and final adjudication of paper/electronic claims • Determine whether to return, deny, or pay claims according to organizational policies and procedures • Review processed claims and inquiries to determine corrective action, including adjusting claims as necessary • Use enrollment, benefit, and historical claim processing information to take corrective action • Coordinate benefits and interact with customers as needed • Complete claims adjustments accurately and timely in response to audits, member/provider calls, other insurance information, appeals, and system changes • Provide technical assistance in researching and resolving inquiries • Receive and process claims by entering and verifying claims data • Resolve claim edits, review history records, determine benefit eligibility, and review payment levels for final payment determination • Escalate issues appropriately while maintaining professional communication with internal and external customers • Meet production and quality standards, maintain accurate records and timekeeping, and attend required training

🎯 Requirements

• High School Diploma/GED • 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 • Reading benefits, investigating edits and making benefit determinations as required in adjusting and adjudicating most types of claims • 1 year claim billing or processing experience preferred

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