{"id":3583799,"url":"https://alion.io/job/highmark-health-claims-processor","title":"Claims Processor","company":{"id":20346,"name":"Highmark Health","domain":"highmarkhealth.org","url":"https://alion.io/company/highmark-health","size_band":"1001-5000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":{"grade":"A","score":100,"open_postings":10,"ghost_share":0,"stale_share":0.1,"repost_share":0,"time_to_fill_p50_days":19,"computed_at":"2026-11-04T06:34:25Z"}},"role":"Industrial Engineering","role_family":"Industrial Engineering","seniority":"junior","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["New York, United States","Washington, United States","United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":null,"salary_estimate":{"min_usd":76000,"max_usd":143000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":185},"experience_years_min":1,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-10-30T00:00:00Z","employer_posted_date":"2026-10-30","last_verified_at":"2026-11-04T08:55:18Z","board_verified":true,"closed_at":null,"days_open":5,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":5},"description":"Company :\nHighmark Inc.Job Description :\nJOB SUMMARY\nThis 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.\nESSENTIAL RESPONSIBILITIES\nReceives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct.\nResolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment levels to arrive at final payment determination. \nElevates issues to next level of supervision as appropriate and ensures a professional line of communication is maintained with internal and external customers.\nMeets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records, including timekeeping records and attends all required training classes. \nOther duties as assigned or requested.\nRequired\nHigh School Diploma/GED\nPreferred\n1 year claim billing or processing experience\nSKILLS\nStrong verbal and written communication skills. \nAbility to take direction and to navigate through multiple systems simultaneously.\nKnowledge of administrative and clerical procedures and systems such as word processing and managing files and records.\nAbility to use mathematics to adjudicate claims.\nAbility to solve problems within pre-defined methods and guidelines.\nKnowledge of operating systems specific to claim processing.\nAbility to review claims and analyze critical data.\nReading benefits, investigating edits and making benefit determinations as required in adjusting and adjudicating most types of claims.\nResearches and finalizes claims, adjustments, inquiries and reports as required.\nPosition Type\nRemote\nDisclaimer: 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.\nCompliance 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.\nAs 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. \nFurthermore, 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.\nPay Range Minimum:\n$19.39Pay Range Maximum:\n$24.19Base 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.\nHighmark 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 any category protected by applicable federal, state, or local law.\nCalifornia Consumer Privacy Act Employees, Contractors, and Applicants Notice","description_format":"text","description_chars":4531,"description_truncated":false,"requirements":{"experience_years_min":1,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"high_school","optional":false},"security_clearance":false,"languages":[]},"benefits":["Equity","Health insurance"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Hospitals & Health Systems","Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-11-01T06:54:43Z"}],"visa":[{"country":"US","licensed_sponsor":true,"evidence":"H-1B filings in 12 months: 34","filings_12m":34,"filings_prev_12m":38,"green_card_filings_12m":0,"median_offered_wage_usd":132500,"route":null,"cap_exempt":false,"checked_at":"2026-10-29T16:27:21+00:00","sources":["US Department of Labor: LCA disclosure data (H-1B, H-1B1, E-3)"],"filings_for_role_12m":0}],"liveness":{"score":90,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.903,"p_room":1,"age_days":5,"expected_fill_days":19,"reasons":["conf:5","velocity","win:early","comp:junior,brand"],"computed_at":"2026-11-04T06:34:25Z"},"pay":null,"html_url":"https://alion.io/job/highmark-health-claims-processor","json_url":"https://alion.io/job/highmark-health-claims-processor.json","meta":{"generated_at":"2026-11-04T13:23:06Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":20258,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-11-05T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":20346},"rest":"https://alion.io/mcp/rest/get_company?id=20346"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fhighmark-health-claims-processor"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fhighmark-health-claims-processor"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fhighmark-health-claims-processor"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/highmark-health-claims-processor\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fhighmark-health-claims-processor"}],"agent":{"mcp":"https://alion.io/mcp/jobs","mcp_open":"https://alion.io/mcp/open","next":[{"tool":"get_job","arguments":{"id":3583799}},{"tool":"search_jobs","arguments":{"company":"highmarkhealth.org","detail":"compact"}},{"tool":"match_people","arguments":{"job_id":3583799},"note":"people open to offers who fit this vacancy"}],"note":"The same data through MCP tools: https://alion.io/mcp/open needs no sign-in (compact searches, postings, people); https://alion.io/mcp with an Alion account has everything. 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