You haven't searched anything yet.
JOB SUMMARY
This job is responsible for 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 and takes the 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 which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes, etc.; provides technical assistance in researching and resolving inquiries.
ESSENTIAL RESPONSIBILITIES
EDUCATION
Required
Substitutions
Preferred
EXPERIENCE
Required
Preferred
LICENSES or CERTIFICATIONS
Required
Preferred
SKILLS
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Never
Travel regularly from the office to various work sites or from site-to-site
Never
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Never
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$16.50Pay Range Maximum:
$22.20Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )
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 number below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Full Time
Insurance
$45k-57k (estimate)
03/27/2024
05/26/2024
highmark.com
WILMINGTON, DE
15,000 - 50,000
1996
NGO/NPO/NFP/Organization/Association
TIM CONSTANTINE
$10B - $50B
Insurance
Highmark Health provides healthcare services and financing network in Pittsburgh.
The job skills required for Claims Processor include Written Communication, Claim Processing, Health Insurance, Claim Reviews, etc. Having related job skills and expertise will give you an advantage when applying to be a Claims Processor. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Claims Processor. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Claims Processor positions, which can be used as a reference in future career path planning. As a Claims Processor, it can be promoted into senior positions as a Claims Clerk III that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Claims Processor. You can explore the career advancement for a Claims Processor below and select your interested title to get hiring information.
If you are interested in becoming a Claims Processor, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Claims Processor for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Claims Processor job description and responsibilities
Respond to customer questions, provide guidance on how to file claims and communicate to customers through phone call, email and chat systems.
02/12/2022: Springfield, OR
Claims Processor prepares daily reports for claims management team.
04/30/2022: Fort Myers, FL
Determines whether to return, deny, or pay claims according to organizational policies and procedures.
03/15/2022: Santa Cruz, CA
Claims Processor is responsible for inputting new claims, processing payments, conducting billing research and responding to telephone inquires.
03/06/2022: Helena, MT
For standard claims, a claims processor can calculate the claim amount and pay checks to clients.
04/14/2022: Greenville, MS
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Claims Processor jobs
The time to send the acknowledgement email for each of the claims case should be set based on the customer type.
04/26/2022: Fresno, CA
An onset date should be recorded on all accident related claims.
02/19/2022: Greensboro, NC
Stop Wasting Time on Manual Administrative Tasks.
02/18/2022: Wilmington, DE
Deliver a Top Notch Client Experience.
03/12/2022: Sarasota, FL
When they’re not verifying and paying claims, processors have several administrative responsibilities.
03/02/2022: Cleveland, OH
Step 3: View the best colleges and universities for Claims Processor.