Listing information dated 2026-11-08
Claims Adjuster Blue Card-3 OPEIU
Highmark Health · NY, Working at Home - New York
Employer listing
Job description
Highmark Inc.
Provides customers with complete, accurate and timely claims review and performs adjustments of claims relative to Blue Card claims administration and claims related tasks. This is a bargaining unit position. The collective bargaining agreement for this position requires that candidates and employees reside in the following counties in the State of New York: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, or Wyoming.
Adjusts Blue Card claims under provisions of applicable contracts, provider operating agreements and corporate procedures through the performing of on-line transactions and /or adjustments utilizing the corporate claims administration system. Identifies potential fraudulent cases and forwards to Special Investigations Department for further review. Identifies opportunities to resolve issues on behalf of the customer, through process improvement requests. Provides necessary documentation to management for recommendations on changes in departmental procedures/desk levels.
Initiates correspondence and/or telephone contact incidental to general claims administration/adjustments and/or assignments. Answers written and/or verbal inquires/correspondence from internal and/or external customers.
Maintains accurate daily production records as needed.
Maintains confidentiality and adheres to HIPAA regulations.
Delivers service to internal and/or external customers in a professional, polite and efficient manner.
Performs all job duties efficiently and at an acceptable rate of performance.
Other duties as assigned or requested.
Requirements
- Healthcare or insurance related experience; claims processing experience; knowledge of medical terminology.
- Previous claims processing or equivalent experience.
- Must meet minimum qualifications to perform the job including satisfactory completion of all training and testing, inlcduing Basic Computer Literacy test, Typing Skills: 30WPM, and Job Content test.
- Ability to multitask if fast paced environment.
- Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills.
- Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner
- Ability to utilize basic office equipment.
- Problem Solving. Identified issues and problems; identifies opportunities for improved claims processing.
- High School/GED
- None
- None
- None
- 0% - 25%
- Travel from the office to various work sites or from site-to-site
- Works primarily out-of-the office selling products/services (sales employees)
- No
- 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.
- $22.46 The starting hourly rate for this position listed above is for new employees. This rate has been established by the Local 153, Office and Professional Employee International Union (OPEIU) collective bargaining agreement (CBA) and is non-negotiable. If the successful candidate is currently a bargaining unit member of the OPEIU, hourly rate is commensurate with their anniversary year and pay grade as per the CBA. 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 any category protected by applicable federal, state, or local law. California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Before you apply
What to know before applying
Check before applying
- • Ask for the pay range before investing much interview time
- • Confirm exactly how remote or hybrid the working pattern is
- • Check which requirements are mandatory versus preferred
- • Confirm certification, production targets, EHR/coding systems, and payer or specialty exposure
Missing or unclear
- • Employment type is not stated in the source
- • Workplace arrangement is not stated or is conflicting in the source
- • Pay range is not clearly listed
These checks are based on the listing, not an assessment of your eligibility. Confirm important details with the employer.