Adjudicator, Provider Claims (Inbound Call Center) Remote in Ohio

Molina Healthcare; Columbus (OH); Remote; USD 23,000 - 44,000; Full time

Job summary

Molina Healthcare is hiring a Provider Claims Adjudicator. This remote role requires living in Ohio and focuses on high-volume inbound calls from providers to resolve claim issues. You will review, adjust, and adjudicate provider claims with a focus on accuracy and timely service.

Responsibilities include researching adjustments, maintaining documentation, and collaborating with enrollment and claims teams to address issues. Strong communication is essential.

Qualifications

• At least 2 years in a clerical claims or customer service role within a managed care org.
• Experience researching and resolving provider claim issues.
• Strong data analysis, organization, and time-management skills.
• Excellent verbal and written communication; proficient with MS Office.

Responsibilities

• Adjudicate or readjudicate high volumes of provider claims promptly.
• Handle inbound calls from providers; document interactions and resolutions.
• Research tracers, adjustments, and resubmissions of claims.
• Collaborate with internal teams to resolve claims issues and ensuring quality.
• Support provider claims adjudication activities and respond to inquiries.

Skills

Managed Care / MCO claims

Call center claims experience

Billing & Appeals and Grievances

Provider customer service

Claims adjudication / research

Documentation and communication

Data analysis

Tools

Microsoft Office

Job description

Adjudicator, Provider Claims (Inbound Call Center) Remote in Ohio

Columbus, OH, United States and 9 more

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Job Description

Molina Healthcare is hiring a Provider Claims Adjudicator. This position is remote; however candidates must live in Ohio.
This position is heavy inbound phone calls from Providers.
This position will be assisting Providers with live claim adjustments, eligibility updates, and/or COBs.

Hours will be Monday through Friday 1130am to 8pm EST.

Highly qualified candidates will have the following experience

• Managed Care / MCO claims experience
• Call center claims experience is highly preferred
• Billing & Appeals and Grievances
• Provider Customer service and/or Member experience
• Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.
• 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.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficient

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Job Info

• Job Schedule Full time
• Salary Range $16.40 - $31.97 Hourly *Actual compensation may vary based on geographic location, work experience, education and/or skill level