Examiner, Claims (must reside in Florida)

Molina Healthcare; Florida; On-site; USD 21,000 - 36,000; Full time

Job summary

Molina Healthcare in Florida is seeking a Claims Examiner to support claims examination activities, evaluating adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors.

The role involves managing a caseload, procuring medical records, and making recommendations for investigation or resolution. Strong data entry, organizational skills, and proficiency with Microsoft Office are required; Medicaid experience is a plus.

Qualifications

• Data entry and research skills.
• Organizational skills and attention to detail.
• Time-management skills to handle multiple tasks.

Responsibilities

• Evaluates the adjudication of claims using standard principles to identify coding issues, abuse, or fraud.
• Manages a caseload of claims and procures supporting medical records.
• Makes recommendations for further investigation or resolution of claims.
• Reduces defects by identifying error trends and proposing solutions in pre-payment processing.
• Meets claims department quality and production standards.
• Supports 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 & 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

Pay Range: $15 - $26.42 / HOURLY

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