Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
Claims Examiner II
Location: Birmingham, AL
Work Schedule: After a period of 100% onsite training, this position will transition to mostly remote with occasional work needed at the Viva Health headquarters in downtown Birmingham.
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
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 processing professional and facility medical, dental and vision claims in accordance with regulatory guidelines and contractual agreements based on VIVA HEALTH guidelines. This position will assist with additional duties such as reports, following up with departments on routed claims and other duties assigned by management.
Key Responsibilities
REQUIRED:
PREFERRED: