Claims Resolution Specialist

Become an integral part of our team as a Claims Resolution Specialist, where you will actively contribute to the management and adjudication of provider claims. Your expertise will enable you to resolve claims inquiries, investigate discrepancies, and achieve efficient outcomes in a dynamic call center environment.

Essential Job Duties

Handle incoming calls from providers to address claims inquiries, delivering exceptional customer service and accurately documenting all interactions.

Resolve claims issues by identifying incorrect payments and collaborating closely with operational teams to facilitate prompt resolutions.

Work in partnership with member enrollment, provider information management, benefits configuration, and claims processing teams to effectively tackle claims-related challenges.

Assist in the review of state and federal complaints concerning claims to ensure compliance and quality.

Conduct thorough investigations of claims tracers, adjustments, and resubmissions to ensure accuracy.

Adjudicate or re-adjudicate a high volume of claims promptly, maintaining excellent quality standards.

Promote continuous improvement by identifying claims error issues, proposing potential solutions, and communicating them to leadership.

Meet departmental quality and productivity standards while supporting initiatives aimed at enhancing the overall claims function efficiency.

Complete basic claims-related projects as assigned.

Required Qualifications

At least 2 years of experience in clerical roles related to claims or customer service, including hands-on experience in investigating and resolving provider claims within a managed care organization.

Strong analytical skills with a knack for research and data analysis.

Excellent organizational skills and a keen attention to detail.

Effective time-management skills to juggle multiple projects simultaneously and meet deadlines.

Demonstrated customer service experience with a focus on provider relations.

Strong verbal and written communication abilities.

Proficiency in Microsoft Office suite and relevant software applications.

If you are driven to make a meaningful impact and meet the qualifications outlined above, we invite you to apply. Join Molina Healthcare and enjoy a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.65 - $38.37 / HOURLY.

*Compensation may vary based on location, experience, education, and skills.