Provider Claims Resolution Specialist

Molina Healthcare; Fort Thomas (KY); On-site; USD 21,000 - 44,000; Full time

Job summary

Molina Healthcare is seeking a claims adjudication support specialist in Kentucky to address provider claim issues and inquiries. You will collaborate with enrollment, information management, benefits configuration, and processing teams to resolve questions efficiently.

The role requires strong data analysis, organizational, and communication skills, along with proficiency in Microsoft Office. Prior experience in a managed care setting is preferred.

Qualifications

• 2+ years in a clerical role in claims or customer service, especially provider claims investigation or resolution.

Responsibilities

• Provide support for resolution of provider claims issues, including analyzing errors and facilitating resolution with billing teams.
• Respond to provider inquiries by phone or email, document interactions, and ensure accurate case notes.
• Review state and federal complaints related to claims and assist in investigations.
• Collaborate with internal departments to determine appropriate claim resolutions.
• Research claims tracers, adjustments, and resubmissions; readjudicate high volumes promptly.
• Identify common claim errors and suggest process improvements to leadership.

Skills

Claims research

Customer service

Data analysis

Organization

Verbal and written communication

Time management

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a claims adjudication support specialist in Kentucky to address provider claim issues and inquiries. You will collaborate with enrollment, information management, benefits configuration, and processing teams to resolve questions efficiently.

The role requires strong data analysis, organizational, and communication skills, along with proficiency in Microsoft Office. Prior experience in a managed care setting is preferred.