Claims Examiner II
Viva Health•Birmingham, AL
•Onsite
About The Position
The Claims Examiner II administers claims adjudication in accordance with contractual agreements and VIVA HEALTH guidelines. The role also supports reporting and follows up with departments on routed claims. The position is located in Birmingham, Alabama, and requires availability during core operating hours of 8 a.m. to 5 p.m., Monday through Friday, with overtime as required.
Requirements
- At least 1–2 years of claims processing experience.
- Two years of college or equivalent claims adjudication experience.
- Ability to work effectively in a production environment where quality and quantity are measured, including recognizing and correcting quality errors.
- Excellent written and verbal communication and customer service skills.
- Organized, detail-oriented, and able to prioritize and multitask.
- Ability to work in a team, adapt to change, recognize responsibilities, and collaborate to complete assignments and achieve goals.
- Knowledge of medical terminology, ICD, CPT, and HPCS.
- Basic computer skills, including Microsoft Word, Excel, and Outlook.
- Understanding of a Claims Payment System to process claims and prepare reports and correspondence.
- Availability to work 8 a.m. to 5 p.m. Monday through Friday and overtime as required.
Nice To Haves
- Professional and/or hospital claims adjudication experience, preferably in the healthcare or medical field.
- CRT data entry experience.
Responsibilities
- Adjudicate provider- and member-submitted claims assigned through the claims workflow.
- Review claims for required information, pend claims when necessary, maintain a follow-up system, and update and release pending claims when indicated.
- Match authorizations correctly so claims are processed according to established guidelines.
- Work with internal departments to resolve issues that prevent claims from processing or improve processing capabilities.
- Meet and maintain department performance and quality measurements required to support regulatory compliance.
- Assist with reports and follow up with departments on routed claims.
Benefits
- Comprehensive health, vision, and dental coverage.
- 401(k) savings plan with company match and immediate vesting.
- Paid time off (PTO).
- Nine paid holidays annually plus a floating holiday.
- Tuition assistance.
- Flexible Spending Accounts.
- Healthcare Reimbursement Account.
- Paid parental leave.
- Community service time off.
- Life insurance and disability coverage.
- Employee wellness program.
- Training and development programs.
- Employee Assistance Program.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
