Adjudicator, Provider Claims - Remote (Inbound Provider Calls)

Molina Talent Acquisition; United States; Remoto; USD 40.000 - 60.000; Tempo pieno

Descrizione del lavoro

Molina Healthcare, Inc. is seeking a provider claims support specialist to assist with responding to providers, researching claim issues, and ensuring timely, accurate resolution.

You will collaborate with claims processing, member enrollment, and benefits teams to address provider questions, document calls, and meet quality and production standards.

The role emphasizes customer service, data analysis, and clear communication to maintain high satisfaction and efficient operations.

Competenze

• At least 2 years of clerical experience in claims or customer service within a managed care setting.
• Experience researching and resolving provider claim issues and reimbursement methods.
• Strong data analysis and attention to detail to ensure accurate resolutions.
• Effective verbal and written communication with providers and internal teams.

Mansioni

• Supports resolution of provider claims issues, analyzes systems, and collaborates with provider billing to resolve.
• Responds to provider calls regarding claims inquiries with strong customer service and documents interactions.
• Collaborates with enrollment and benefits teams to address provider claim questions and issues.
• Assists in reviews of state and federal complaints related to claims and supports process improvements.

Conoscenze

Research and data analysis

Customer service

Verbal and written communication

Time-management

Attention to detail

Microsoft Office proficiency

Formazione

High school diploma or equivalent

Strumenti

Provider claims systems

Descrizione del lavoro

Mon - Fri

Closing shift

12pm -8:30pm EST

11am - 7:30pm CST

10am - 6:30pm MST

9am - 5:30pm PST

Inbound Provider Call

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.

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