Provider Claims Adjudication Specialist

Molina Healthcare, Inc.; United States; Remote; USD 20,000 - 44,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a Provider Claims Adjudication Support Specialist to assist with provider claims issues, respond to providers, and research resolutions.

You will collaborate with the enrollment, provider information management, benefits configuration and claims teams, respond to calls with strong customer service, and help ensure timely adjudication and quality standards. Mon-Fri, closing shifts are available, with varying start times to align with EST/CST/MST/PST time zones,

Qualifications

• 2+ years in a clerical role in a claims or customer service setting, including provider claims investigation or research.
• Strong data analysis and organizational skills with attention to detail.
• Able to manage multiple tasks to meet deadlines and deliver accurate results.
• Solid verbal and written communication, with proficient Microsoft Office usage.

Responsibilities

• Provides support for provider claims adjudication, addressing issues and researching resolutions.
• Collaborates with enrollment, provider information management, benefits configuration and claims processing teams.
• Responds to provider inquiries with strong customer service and documents all interactions.
• Assists in reviews of state and federal complaints related to claims.
• Researches tracers, adjustments, and resubmissions; adjudicates high volumes timely.
• Supports claims department initiatives to improve efficiency and quality standards.

Skills

Claims research

Customer service

Data analysis

Time management

Organizational skills

Verbal & written communication

Tools

Microsoft Office

Job description

Molina Healthcare, Inc. is seeking a Provider Claims Adjudication Support Specialist to assist with provider claims issues, respond to providers, and research resolutions.

You will collaborate with the enrollment, provider information management, benefits configuration and claims teams, respond to calls with strong customer service, and help ensure timely adjudication and quality standards. Mon-Fri, closing shifts are available, with varying start times to align with EST/CST/MST/PST time zones,