VIVA HEALTH · 10 hours ago
Claims Examiner II
Birmingham, Alabama, United States
Full-time
Onsite
Entry Level
1+ years expVIVA HEALTH is a healthcare organization seeking a Claims Examiner II to manage claims adjudication processes in line with contractual agreements and company guidelines. The role involves reviewing claims, ensuring compliance with established guidelines, and collaborating with internal departments to resolve processing issues.
Health CareInsurance
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
Qualification
Required
At least 1–2 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
Company
VIVA HEALTH
VIVA HEALTH is the preferred healthcare provider which provides Health Insurance, Medicare, Medicaid and Healthcare.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
C
Cardwell Feagin
COO
Recent News
2025-05-16
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