Associate Claims Processor

Job description

Company: Highmark Inc. Job Description: 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 and takes the corrective action steps using enrollment, benefit, and historical claim processing information. ESSENTIAL RESPONSIBILITIES: ​ - Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct. (40%) - Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment levels to arrive at final payment determination; elevates issues to next level of supervision, as appropriate. (35%) - Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records including timekeeping records. (15%) - Attends all required training classes. ( 10%) - Other duties as assigned or requested. EDUCATIO...