Claims Examiner II

Claims Examiner IIThe 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.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 and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.BenefitsComprehensive Health, Vision, and Dental Coverage401(k) Savings Plan with company match and immediate vestingPaid Time Off (PTO)9 Paid Holidays annually plus a Floating Holiday to use as you chooseTuition AssistanceFlexible Spending AccountsHealthcare Reimbursement AccountPaid Parental LeaveCommunity Service Time OffLife Insurance and Disability CoverageEmployee Wellness ProgramTraining and Development Programs to develop new skills and reach career goalsEmployee Assistance ProgramKey ResponsibilitiesAdjudicate 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.RequiredAt least 1–2 years of experience with claims processing2 years of college or equivalent claims adjudication experienceAbility to thrive in a production environment where quality and quantity are highly measured, including recognizing and correcting quality errorsDemonstrate excellent customer service skills through written and verbal communicationOrganized, detail oriented, and skilled at prioritizing and multitaskingAbility to work in a team environment, remain flexible to changes, and recognize responsibilities, actively participate with others to accomplish assignments and achieve desired goalsKnowledge of medical terminology, ICD, CPT, and HPCSBasic computer skills including Microsoft Word, Excel, and OutlookUnderstanding of Claims Payment System in order to process claims, prepare reports and correspondencePreferredProfessional and/or hospital claims adjudication experience, preferably in the healthcare/medical fieldCRT data entry experienceEqual Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. VIVA Health