Provider Claims Adjudicator (Remote)

Job Summary

As a Provider Claims Adjudicator, you will provide essential support for provider claims adjudication activities. This includes responding to providers regarding claim issues, conducting thorough research and investigation, and ensuring appropriate resolution of claims within Molina Healthcare.

Essential Job Duties

• Provides support for the resolution of provider claims issues, including claims paid incorrectly.
• Analyzes systems and collaborates with respective operational areas and provider billing to facilitate claims resolution.
• Collaborates with member enrollment, provider information management, benefits configuration, and claims processing teams to address provider claim issues.
• Responds to incoming calls from providers concerning claims inquiries, providing excellent customer service, support, and issue resolution; all calls and interactions are thoroughly documented.
• Assists in reviews of state and federal complaints related to claims.
• Collaborates with other internal departments to determine appropriate resolution of claims issues.
• Researches claims tracers, adjustments, and resubmissions of claims.
• Adjudicates or readjudicates high volumes of claims in a timely manner.
• Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
• Meets claims department quality and production standards.
• Supports claims department initiatives to improve overall claims function efficiency.
• Completes basic claims projects as assigned.

Required Qualifications

• At least 2 years of experience in a clerical role in a claims and/or customer service setting.
• Experience in provider claims investigation, research, resolution, and reimbursement methodology analysis within a managed care organization, or an equivalent combination of relevant education and experience.
• Strong research and data analysis skills.
• Exceptional organizational skills and attention to detail.
• Effective time-management skills, with the ability to manage simultaneous projects and tasks to meet internal deadlines.
• Proven customer service experience.
• Effective verbal and written communication skills.
• Proficiency in Microsoft Office suite and applicable software programs.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $14.76 - $31.97 / HOURLY

Key skills/competency

• Claims Adjudication
• Provider Relations
• Customer Service
• Data Analysis
• Claims Resolution
• Managed Care
• Microsoft Office
• Communication Skills
• Time Management
• Attention to Detail