Senior Examiner, Claims at Molina Healthcare

Long Beach, California, United States -

Full Time

Start Date

Immediate

Expiry Date

26 Aug, 26

Salary

0.0

Posted On

28 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Examination, Claims Adjudication, Medical Coding, Fraud Detection, Case Management, Regulatory Compliance, Data Entry, Time Management, Customer Service, Microsoft Office Suite, Written Communication, Verbal Communication

Industry

Hospitals and Health Care

Description

JOB DESCRIPTION Job Summary Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. Essential Job Duties • Evaluates the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors. • Manages a caseload of claims - procures all medical records and statements that support the claim. • Makes recommendations for further investigation and/or resolution of claims. • Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication, and recommends solutions to resolve issues. • Identifies and recommends solutions for error issues as it relates to pre-payment of claims. • Monitors the medical treatment of claimants; keeps meticulous notes and records for each claim. • Manages a caseload of various types of complex claims - procures all medical records and statements that support the claim. • Meets state and federal regulatory compliance regulations on turnaround times and claims payment for multiple lines of business (LOBs). • Meets department quality and production standards. • Supports all claims department initiatives to improve overall efficiency. • Completes claims projects as assigned. Required Qualifications • At least 2 years of experience in claims, and/or customer service experience in a clerical role - preferably in a managed care setting, or equivalent combination of relevant education and experience. • Research and data entry 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. Preferred Qualifications • Health care claims/billing experience. #PJClaims3 #LI-AC1 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

Provides senior-level support for claims examination by evaluating adjudication to identify coding errors, fraud, and overpayments. Manages a caseload of complex claims while ensuring compliance with state and federal regulatory turnaround times.