Impress employers and recruiters.
Choose from hundreds of resume examples.
Impress employers and recruiters.
Choose from hundreds of resume examples.
Tailor your resume to this Claims Processor role.
Rezi rewrites your resume against Highmark Health's job description. Free.
Tailor your resume to this Claims Processor role.
Rezi rewrites your resume against Highmark Health's job description. Free.
Don't guess if your resume is good enough.
See how it scores against the Claims Processor posting at Highmark Health — free, in seconds.
Don't guess if your resume is good enough.
See how it scores against the Claims Processor posting at Highmark Health — free, in seconds.
About the Role
This position is responsible for screening, reviewing, evaluating online entry, correcting errors, and performing quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny, or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action, including adjusting claims as necessary, and takes corrective action steps using enrollment, benefit, and historical claim processing information. May coordinate benefits and interact with customers. Responsible for the timely and accurate completion of claims adjustments resulting from audits, member/provider calls, other insurance information, appeals, and system changes. Provides technical assistance in researching and resolving inquiries. This position works standard Eastern Time business hours.
Responsibilities
- Receives and processes claims, including 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 the next level of supervision as appropriate and ensures a professional line of communication is maintained with internal and external customers.
- Meets all production and quality standards, ensuring timeliness and accuracy of all work.
- Maintains accurate records, including timekeeping records.
- Attends all required training classes.
- Performs other duties as assigned or requested.
Requirements
- High School Diploma/GED
- 1 year of related experience
- 1 year of claims processing experience (preferred)
- Inquiry resolution system, OCWA, Oscar, Outlook experience (preferred)
Skills
- Strong verbal and written communication skills.
- Ability to take direction and 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.
- Researches and finalizes claims, adjustments, inquiries, and reports as required.
Location
- Remote
Work Type
- Remote Office-based
Experience Level
- 1 year of related experience
- 1 year of claims processing experience
Education Level
- High School Diploma/GED
Salary/Compensations
- $19.39 - $24.19
About the Company
- Highmark Inc.
Equal Opportunity
- Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
- We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
- For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
- California Consumer Privacy Act Employees, Contractors, and Applicants Notice