Examiner, Claims (Remote)

Molina Healthcare, Inc.; United States; À distance; USD 42 000 - 65 000; Plein temps

Résumé du poste

Molina Healthcare, Inc. is seeking a Claims Support professional to assist in evaluating claim adjudication, identifying errors, and supporting fraud prevention efforts.

The role involves managing a caseload, gathering records, and recommending investigations to resolve claims. The position emphasizes strong communication, data entry, and organizational skills, with experience in a managed care or related environment being preferred.

Qualifications

• 1 year of clerical claims or customer service experience.
• Proficient data entry and research abilities.
• Strong organizational skills and attention to detail.

Responsabilités

• Evaluates adjudication of claims to identify errors and fraud.
• Manages a caseload and procures supporting medical records.
• Recommends investigations or resolutions for claims.
• Identifies pre-payment defects and suggests corrective actions.
• Meets department quality and production standards.
• Supports initiatives to improve claims processing efficiency.
• Completes basic claims projects as assigned.

Connaissances

Data entry

Research skills

Attention to detail

Time management

Customer service

Verbal and written communication

Microsoft Office

Outils

Microsoft Office

Description du poste

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