Claims Examiner II
Claims Examiner II
Location: Birmingham, AL
Work Schedule: Mostly remote after approximately 6 months of required onsite training at the VIVA HEALTH corporate office.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
Comprehensive Health, Vision, and Dental Coverage
401(k) Savings Plan with company match and immediate vesting
Paid Time Off (PTO)
9 Paid Holidays annually plus a Floating Holiday to use as you choose
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 to develop new skills and reach career goals
Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Claims Examiner II will administer all claims adjudication processes in accordance with contractual agreements along with VIVA HEALTH guidelines. This position will assist with additional duties such as reports and following up with departments on routed claims. Must be available to work during the core hours of operation, 8am to 5pm Monday through Friday, and overtime as required.
Key Responsibilities
Adjudicate claims submitted by providers and members assigned via claims workflow.
Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.
Correctly match authorizations to ensure claims are processing appropriately based on established guidelines.
Work with internal departments to resolve issues preventing claims from processing or enhancing processing capabilities.
Meet and maintain performance and quality measurements as required by the department to meet regulatory compliance standards.
REQUIRED:
At least 12 years of experience with claims processing
2 years of college or equivalent claims adjudication experience
Ability to thrive in a production environment where quality and quantity are highly measured, including recognizing and correcting quality errors
Demonstrate excellent customer service skills through written and verbal communication
Organized, detail oriented, and skilled at prioritizing and multitasking
Ability to work in a team environment, remain flexible to changes, and recognize responsibilities, actively participate with others to accomplish assignments and achieve desired goals
Knowledge of medical terminology, ICD, CPT, and HPCS
Basic computer skills including Microsoft Word, Excel, and Outlook
Understanding of Claims Payment System in order to process claims, prepare reports and correspondence
PREFERRED:
Professional and/or hospital claims adjudication experience, preferably in the healthcare/medical field
CRT data entry experience
Apply Now
Location: Birmingham, AL
Work Schedule: Mostly remote after approximately 6 months of required onsite training at the VIVA HEALTH corporate office.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
Comprehensive Health, Vision, and Dental Coverage
401(k) Savings Plan with company match and immediate vesting
Paid Time Off (PTO)
9 Paid Holidays annually plus a Floating Holiday to use as you choose
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 to develop new skills and reach career goals
Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Claims Examiner II will administer all claims adjudication processes in accordance with contractual agreements along with VIVA HEALTH guidelines. This position will assist with additional duties such as reports and following up with departments on routed claims. Must be available to work during the core hours of operation, 8am to 5pm Monday through Friday, and overtime as required.
Key Responsibilities
Adjudicate claims submitted by providers and members assigned via claims workflow.
Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.
Correctly match authorizations to ensure claims are processing appropriately based on established guidelines.
Work with internal departments to resolve issues preventing claims from processing or enhancing processing capabilities.
Meet and maintain performance and quality measurements as required by the department to meet regulatory compliance standards.
REQUIRED:
At least 12 years of experience with claims processing
2 years of college or equivalent claims adjudication experience
Ability to thrive in a production environment where quality and quantity are highly measured, including recognizing and correcting quality errors
Demonstrate excellent customer service skills through written and verbal communication
Organized, detail oriented, and skilled at prioritizing and multitasking
Ability to work in a team environment, remain flexible to changes, and recognize responsibilities, actively participate with others to accomplish assignments and achieve desired goals
Knowledge of medical terminology, ICD, CPT, and HPCS
Basic computer skills including Microsoft Word, Excel, and Outlook
Understanding of Claims Payment System in order to process claims, prepare reports and correspondence
PREFERRED:
Professional and/or hospital claims adjudication experience, preferably in the healthcare/medical field
CRT data entry experience
Apply Now