Claims Examiner - Fraud Detection & Resolution

UnitedHealth Group; United States; A distancia; USD 17.000 - 36.000; Jornada completa

Descripción de la vacante

Molina Healthcare is seeking a claims examiner support specialist to assist in evaluating adjudication of claims, identifying incorrect coding and potential fraud, and supporting processing accuracy.

Responsibilities include managing a caseload, gathering medical records, making recommendations for investigations, and contributing to efficiency initiatives within the claims department. Prior clerical or customer service experience is preferred, with strong communication and computer skills.

Formación

• At least 1 year in a clerical role in a claims, and/or customer service setting.
• Data entry and research 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.

Responsabilidades

• Evaluates the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.
• Manages a caseload of claims - procures all medical records and statements that support the claim.
• Makes recommendations for further investigation and/or resolution of claims.
• Reduces defects through proactive identification of error issues as it relates to pre-payment of claims through adjudication/trend identification, and recommends solutions to resolve issues.
• Meets claims department quality and production standards.
• Supports claims department initiatives to improve overall claims function efficiency.
• Completes basic claims projects as assigned.

Conocimientos

Data entry

Research skills

Organizational skills

Time-management

Customer service

Verbal & written communication

Microsoft Office

Herramientas

Microsoft Office

Descripción del empleo

Molina Healthcare is seeking a claims examiner support specialist to assist in evaluating adjudication of claims, identifying incorrect coding and potential fraud, and supporting processing accuracy.

Responsibilities include managing a caseload, gathering medical records, making recommendations for investigations, and contributing to efficiency initiatives within the claims department. Prior clerical or customer service experience is preferred, with strong communication and computer skills.