Provider Claims Adjudication Specialist

Molina Healthcare Inc; Cincinnati (OH); On-site; USD 42,000 - 52,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a claims support professional in Cincinnati, OH to assist with provider claims adjudication. You will address claim issues, research resolutions, and ensure timely processing while delivering excellent customer service.

The role emphasizes collaboration across enrollment, provider information management, and benefits configuration teams, with a focus on accuracy, efficiency, and regulatory compliance. Equal opportunity employer.

Qualifications

• 2+ years in a clerical claims or customer service role in a managed care setting.
• Experience researching and resolving provider claim issues.
• Strong data analysis, organization and attention to detail.

Responsibilities

• Support resolution of provider claims issues, including incorrect payments.
• Collaborate with enrollment, provider information, benefits, and claims teams to address issues.
• Respond to provider calls about claim inquiries and document interactions.
• Assist in reviews of state and federal complaints related to claims.
• Research tracers, adjustments, and resubmissions of claims.
• Adjudicate/readjudicate high volumes of claims promptly.
• Identify and communicate error issues and potential solutions to leadership.
• Meet claims department quality and production standards.
• Support initiatives to improve claims function efficiency.
• Complete basic claims projects as assigned.

Skills

Claims investigation

Data analysis

Organizational skills

Time management

Customer service

Verbal and written communication

Microsoft Office

Tools

Microsoft Office

Job description

Molina Healthcare, Inc. is seeking a claims support professional in Cincinnati, OH to assist with provider claims adjudication. You will address claim issues, research resolutions, and ensure timely processing while delivering excellent customer service.

The role emphasizes collaboration across enrollment, provider information management, and benefits configuration teams, with a focus on accuracy, efficiency, and regulatory compliance. Equal opportunity employer.