Adjudicator, Provider Claims - Remote (Inbound Provider Calls)

Molina Healthcare; United States; Remote; USD 20,000 - 44,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a Provider Claims Adjudication Support Specialist to assist with provider claims issues, respond to providers, and research resolutions.

You will collaborate with the enrollment, provider information management, benefits configuration and claims teams, respond to calls with strong customer service, and help ensure timely adjudication and quality standards. Mon-Fri, closing shifts are available, with varying start times to align with EST/CST/MST/PST time zones,

Qualifications

• 2+ years in a clerical role in a claims or customer service setting, including provider claims investigation or research.
• Strong data analysis and organizational skills with attention to detail.
• Able to manage multiple tasks to meet deadlines and deliver accurate results.
• Solid verbal and written communication, with proficient Microsoft Office usage.

Responsibilities

• Provides support for provider claims adjudication, addressing issues and researching resolutions.
• Collaborates with enrollment, provider information management, benefits configuration and claims processing teams.
• Responds to provider inquiries with strong customer service and documents all interactions.
• Assists in reviews of state and federal complaints related to claims.
• Researches tracers, adjustments, and resubmissions; adjudicates high volumes timely.
• Supports claims department initiatives to improve efficiency and quality standards.

Skills

Claims research

Customer service

Data analysis

Time management

Organizational skills

Verbal & written communication

Tools

Microsoft Office

Job description

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.

• 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.

Mon - Fri

Closing shift

12pm - 8:30pm EST

11am - 7:30pm CST

10am - 6:30pm MST

9am - 5:30pm PST

Inbound Provider Call

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

Pay Range: $14.76 - $31.97 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.