Examiner, Claims (must reside in Florida)

Molina Talent Acquisition; Florida; On-site; USD 42,000 - 52,000; Full time

Benefits offered by this job

Competitive benefits

Equal opportunity employer

Job summary

Molina Healthcare is seeking a Claims Examiner Support to assist in adjudication evaluation, ensuring accurate coding and detecting potential fraud or errors. You will manage a caseload, gather records, and support investigations to resolve claims efficiently.

The role emphasizes data entry, organizational skills, and strong communication, with MS Office proficiency and a focus on meeting quality and production standards in a managed care environment.

Qualifications

• At least 1 year of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience.
• 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.

Responsibilities

• 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.

Skills

Data entry

Research skills

Organizational skills

Time-management

Customer service

Verbal and written communication

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

Provides support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors.

Essential Job Duties

• 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.

Required Qualifications

• At least 1 year of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience.


• 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.

Preferred Qualifications

• Health care claims/billing experience.


• Medicaid claim processing experience is a plus.

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V