Examiner, Claims (Remote)

Molina Healthcare; United States; Remote; USD 17,000 - 36,000; Full time

Job summary

Molina Healthcare is seeking a detail-oriented Claims Examiner support professional to assist in evaluating claims adjudication, identifying incorrect coding, abuse and fraudulent activities, and supporting resolution of processing errors. The role involves handling a caseload, gathering medical records, and making recommendations for investigations while contributing to efficiency initiatives.

Qualified candidates have at least 1 year in a clerical claims or customer service role, with strong

Qualifications

• 1+ year of clerical experience in claims or customer service, preferably in managed care.
• Data entry and research skills.
• Strong organizational skills and attention to detail.
• Strong time-management to handle multiple tasks and deadlines.
• Customer service experience with effective verbal and written communication.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Evaluates claims adjudication using standard principles and state regulations to identify errors and improper billing.
• Manages a caseload of claims; procures medical records and supporting statements.
• Makes recommendations for investigation or resolution of claims.
• Identifies error trends and suggests solutions to improve pre-payment adjudication.
• Meets department quality and production standards.
• Supports initiatives to improve claims processing efficiency.
• Completes basic claims projects as assigned.

Skills

Data entry

Research skills

Organizational skills

Time management

Customer service

Verbal communication

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.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $12.19 - $26.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.