Claims Adjudication Specialist

Molina Healthcare; Northern (KY); Hybrid; USD 22,000 - 44,000; Full time

Job summary

Molina Healthcare is seeking a detail‑oriented claims support professional in the United States, Kentucky region. The role involves addressing provider claim issues, researching and resolving discrepancies, and ensuring timely adjudication and communication with providers.

The candidate will collaborate across departments, manage multiple tasks, and uphold quality standards while contributing to process improvements within the claims function.

Qualifications

• At least 2 years of clerical experience in a claims or customer service setting.
• Experience in provider claims investigation/research/resolution/reimbursement analysis.
• Strong research and data analysis skills.
• Excellent organizational skills and attention to detail.
• Effective verbal and written communication; proficient in Microsoft Office.

Responsibilities

• Provide support for resolution of provider claims issues, including incorrect payments.
• Collaborate with enrollment, provider information management, benefits configuration and claims processing teams.
• Respond to provider calls regarding claims inquiries and document interactions.
• Assist in reviews of state and federal complaints related to claims.
• Research tracers, adjustments, and resubmissions of claims.
• Adjudicate or readjudicate high volumes of claims in a timely manner.

Skills

Data analysis

Customer service

Time management

Written and verbal communication

Microsoft Office

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a detail‑oriented claims support professional in the United States, Kentucky region. The role involves addressing provider claim issues, researching and resolving discrepancies, and ensuring timely adjudication and communication with providers.

The candidate will collaborate across departments, manage multiple tasks, and uphold quality standards while contributing to process improvements within the claims function.