Adjudicator, Provider Claims

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims in a call center environment.

**Essential Job Duties** - Respond to inbound calls to provide support for provider claims adjudication activities including responding to provider to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.

- Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.

- 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 re-adjudicates 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 Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.