Claims Processor

The Claims Processor position at Highmark Inc. is a critical role responsible for the screening, reviewing, and evaluating of online entries related to claims processing. This includes correcting errors and performing quality control reviews, as well as the final adjudication of both paper and electronic claims. The Claims Processor must determine whether to return, deny, or pay claims in accordance with organizational policies and procedures. This role involves reviewing processed claims and inquiries to identify necessary corrective actions, which may include adjusting claims based on various factors such as internal or external audits, member or provider phone calls, and other insurance information received. The position also requires interaction with customers and coordination of benefits as needed. The Claims Processor is tasked with ensuring the timely and accurate completion of claims adjustments, which may arise from various sources including appeals and system changes. This role provides technical assistance in researching and resolving inquiries, making it essential for the Claims Processor to maintain a high level of accuracy and efficiency in their work. The position demands a strong attention to detail and the ability to navigate multiple systems simultaneously while adhering to production and quality standards set by management. In addition to processing claims, the Claims Processor is responsible for maintaining accurate records, including timekeeping, and attending all required training classes. The role may also involve other duties as assigned or requested by management, making flexibility and adaptability key traits for success in this position.