Adjudicator, Provider Claims-On the phone-closing shift at Molina Healthcare

Long Beach, California, United States -

Full Time

Start Date

Immediate

Expiry Date

11 Aug, 26

Salary

0.0

Posted On

13 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Adjudication, Provider Relations, Data Analysis, Customer Service, Research, Time Management, Microsoft Office, Written Communication, Verbal Communication, Claims Investigation, Reimbursement Methodology, Attention To Detail

Industry

Hospitals and Health Care

Description

JOB DESCRIPTION Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. Essential Job Duties • 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. • Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. • 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, 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. 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

Responsibilities

Responsible for adjudicating provider claims and resolving issues through research and collaboration with internal teams. Provides direct customer support to providers via phone to address claim inquiries and ensure timely resolution.