Claims Processor

Highmark Health

. Screen, review, evaluate online entries, correct errors, and perform quality control review and final adjudication of paper/electronic claims .

Posted 9/24/2026full-timeRemote • United StatesJunior💰 $19 - $24 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims processing, including reviewing, evaluating, and adjudicating claims while ensuring compliance with organizational policies. Proficient in data entry, problem-solving, and maintaining accurate records in a fast-paced environment.

Highest-signal resume keywords

Claims AdjudicationData Entry and VerificationProblem SolvingCustomer InteractionQuality Control

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingMathematics for Claims AdjudicationData AnalysisAdministrative ProceduresClerical Procedures

Soft Skills

CommunicationAttention to DetailAbility to Take Direction

Tools & Technologies

Operating Systems for Claim Processing

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Claims ReviewBenefit EligibilityQuality StandardsCorrective ActionProduction Standards

About the role

Key responsibilities & impact

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 resulting from 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 determine final payment levels
Escalate issues to supervision and maintain professional communication with internal and external customers
Meet production and quality standards while maintaining timely and accurate work
Maintain accurate records, including timekeeping records, and attend required training classes

Requirements

What you’ll need

High School Diploma/GED
1 year of related experience
Ability to take direction and navigate through multiple systems simultaneously
Knowledge of administrative and clerical procedures and systems, including 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
Standard Eastern Time business hours