Senior Claims Processor
Highmark Health
full-time
Posted on:
Location Type: Hybrid
Location: Louisiana • Maryland • United States
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Salary
💰 $20 - $27 per hour
Job Level
About the role
- Screening, reviewing, evaluating online entry, correcting errors and/or 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.
- Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes.
Requirements
- High School Diploma/GED
- 3 years of related experience
- 1 year of claims processing experience
- Knowledge to research and handle complex claims
Benefits
- Health insurance
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingquality controlerror correctionclaims adjustmentauditinginquiry resolutioncomplex claims handling
Certifications
High School DiplomaGED