Provider Claims Adjudication Specialist

Molina Healthcare, Inc.; Oregon; Hybrid; USD 40,000 - 60,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare, Inc. is seeking a Provider Claims Support specialist to assist with adjudication of provider claims and resolution of claim issues. You will respond to provider inquiries, analyze claims data, and work cross-functionally to ensure accurate resolutions.

The role requires strong research, data analysis, organizational skills, and customer service experience, with proficiency in Microsoft Office and related software.

Qualifications

• At least 2 years of clerical experience in claims or customer service within a managed care org, or equivalent.
• Strong research and data analysis skills.
• Excellent organizational and attention to detail abilities.
• Solid time-management skills to handle multiple tasks and deadlines.
• Customer service experience with effective communication (verbal and written).
• Proficiency with Microsoft Office and related software programs.

Responsibilities

• Supports provider claims adjudication activities and resolves claim issues.
• Analyzes systems and collaborates with provider billing to facilitate resolution.
• Responds to provider calls about claims inquiries and documents interactions.
• Assists in reviews of state and federal complaints related to claims.
• Collaborates with internal departments to determine appropriate claim resolutions.
• Researches tracers, adjustments, and resubmissions of claims.
• Adjudicates or readjudicates high volumes of claims timely.
• Identifies defect trends and communicates issues and solutions to leadership.
• Meets claims department quality and production standards.
• Supports initiatives to improve overall claims function efficiency.
• Completes basic claims projects as assigned.

Skills

Data analysis

Organizational skills

Time management

Customer service

Verbal and written communication

Tools

Microsoft Office

Job description

Molina Healthcare, Inc. is seeking a Provider Claims Support specialist to assist with adjudication of provider claims and resolution of claim issues. You will respond to provider inquiries, analyze claims data, and work cross-functionally to ensure accurate resolutions.

The role requires strong research, data analysis, organizational skills, and customer service experience, with proficiency in Microsoft Office and related software.