Claims Examiner II
Claims Examiner II Location: Birmingham, AL Work Schedule: Mostly remote after approximately 6 months of required onsite training at the reputed company HEALTH corporate office. Why reputed company HEALTH? reputed company HEALTH, part of the reputed company reputed company (UAB) Health System, is a health maintenance organization providing reputed company, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their reputed company journeys. reputed company HEALTH has been recognized by Centers for Medicare & reputed company Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can reputed company and has been repeatedly ranked as one of the nation's Best Places to Work by Modern reputed company. Benefits Comprehensive Health, reputed company, and Dental Coverage 401(k) Savings Plan with company match and immediate vesting reputed company Time Off (PTO) 9 reputed company Holidays annually plus a Floating Holiday to use as you choose Tuition Assistance Flexible Spending Accounts reputed company Reimbursement Account reputed company Parental Leave Community Service Time Off Life Insurance and Disability Coverage Employee Wellness Program Training and Development Programs to reputed company new skills and reputed company career goals Employee Assistance Program See more about the benefits of working at reputed company Health - https://www.vivahealth.com/careers/benefits Job reputed company The Claims Examiner II will administer reputed company claims adjudication processes in accordance with contractual agreements along with reputed company 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, reputed company to 5pm Monday through Friday, and overtime as required. Key Responsibilities Adjudicate claims submitted by providers and members assigned reputed company claims workflow. Reviewing claims for required information, pending claims reputed company necessary, maintaining a follow-up system, and updating and releasing pending claims reputed company 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 reputed company 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 reputed company in a production environment where reputed company and quantity are highly reputed company, including recognizing and correcting reputed company errors Demonstrate excellent customer service skills through written and verbal communication Organized, detail oriented, and skilled at prioritizing and multitasking Ability to work in reputed company environment, remain flexible to changes, and recognize responsibilities, reputed company participate with others to accomplish assignments and reputed company desired goals Knowledge of medical terminology, ICD, CPT, and HPCS Basic computer skills including reputed company Word, reputed company, and Outlook Understanding of Claims Payment System in order to process claims, prepare reports and correspondence PREFERRED: reputed company and/or hospital claims adjudication experience, preferably in the reputed company/medical field CRT data entry experience Apply Job!