Claims Examiner

PangeaTwo; Birmingham (AL); On-site; USD 22,000 - 30,000; Full time

Job summary

PangeaTwo in Birmingham, AL is seeking a detail-oriented Claims Examiner to adjudicate complex claims in a fast-paced environment. You will ensure accuracy in line with contracts and internal guidelines to support timely processing for members and providers downtown.

This role emphasizes reliability, efficiency, and strong communication with internal teams. Experience with healthcare claims software and a customer-centric mindset are essential for success in a temp-to-perm opportunity.

Qualifications

• 1–2 years of dedicated healthcare claims processing experience.
• 2+ years of college education or equivalent practical claims adjudication experience.
• Familiarity with industry-standard claims software.
• Thrives in a metric-driven production environment balancing speed and accuracy.
• Strong organizational skills with multitasking and time management.
• Excellent written and verbal communication with a customer-centric mindset.
• Exceptional attention to detail and error-detection aptitude.

Responsibilities

• Adjudicate incoming member and provider claims efficiently through established workflow queues.
• Review claims for completeness and manage pending files; release or update as appropriate.
• Cross-reference prior authorizations to ensure accurate processing per guidelines.
• Collaborate with internal departments to resolve workflow roadblocks and exceptions.
• Maintain adherence to department performance standards for speed and quality.
• Generate routine reports and follow up on routed or escalated claims.
• Uphold compliance and protect confidential member and provider information.

Skills

Attention to detail

Time management

Customer service

Claims software

Education

College coursework

Tools

Claims software

Job description

Claims Examiner

Claims Examiner

$19 an hour

Birmingham, AL

Our client is seeking a detail-oriented and reliable Claims Examiner to join a growing operations team at a prominent local health insurance organization. In this role, you will be responsible for administering complex claims adjudication processes in strict alignment with contractual agreements and internal guidelines. If you thrive in a fast-paced production environment where accuracy and efficiency are paramount, possess solid experience with healthcare claims software and are looking for a stable temp-to-permanent opportunity downtown, we want to hear from you.

Job Duties

• Adjudicate incoming member and provider claims efficiently through established workflow queues
• Review claims for completeness, manage pending files, and release or update claims as appropriate
• Cross-reference prior authorizations to ensure accurate claims processing based on regulatory guidelines
• Collaborate with internal departments to resolve workflow roadblocks and processing exceptions
• Maintain strict adherence to department performance standards for production speed and quality
• Generate routine reports and follow up on routed or escalated claims
• Uphold compliance standards and protect confidential member and provider information

Job Requirements

• Minimum of 1 to 2 years of dedicated healthcare claims processing experience
• 2+ years of college education or an equivalent combination of practical claims adjudication experience
• Prior familiarity with industry-standard claims software
• Proven ability to thrive in a metric-driven production environment balancing speed and precision
• Strong organizational skills with the ability to multitask, prioritize, and manage time effectively
• Excellent written and verbal communication skills with a customer-centric mindset
• Exceptional attention to detail and a natural aptitude for error detection and correction

At our clients’ request, only individuals with required experience will be considered.

Please note - if you have recently submitted your resume to a PangeaTwo posting, your qualifications will be considered for other open opportunities.

Your resume will never be submitted to a client without your prior knowledge and consent to do so.