Molina Healthcare logo
Molina Healthcare

Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M

Adjudicator, Provider Claims

Location

United States

Posted

2 days ago

Salary

$15 - $32 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Adjudicator, Provider Claims

Molina Healthcare

Role Description Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. Hours - M-F 12pm - 8:30pm EST Essential Job Duties - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Strong claims adjusting experience as well as customer services, problem solving, critical thinking skills and research and resolution skills. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - 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. Qualifications - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. Requirements - Knowledgeable in Systems Utilized: - Salesforce - QNXT - Pega - Claim Shark - Cotiviti Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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