Provider Claims Resolution Specialist

Molina Healthcare; Kentucky; On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare is seeking a claims support professional in the United States (Kentucky) to assist with provider claims adjudication and issue resolution. You will address inquiries, analyze claims problems, and collaborate across departments to ensure timely, accurate resolutions.

The role emphasizes attention to detail, strong communication, and adherence to established quality standards, with opportunities to contribute to claims process improvements within a supportive team environment.

Qualifications

• 2+ years in a clerical claims or customer service role within managed care or similar setting.
• Strong research and data analysis capabilities.
• Detail-oriented with solid organizational skills and ability to manage multiple tasks.

Responsibilities

• Support resolution of provider claims issues and investigate incorrect payments.
• Collaborate with enrollment, provider information, benefits configuration, and claims teams.
• Handle provider inquiries via calls and document interactions.
• Assist in reviews of state and federal complaints related to claims.
• Coordinate with internal departments to resolve claims issues.
• Research tracers, adjustments, and resubmissions of claims.
• Adjudicate or readjudicate high volumes of claims promptly.
• Identify and communicate defect trends and potential solutions to leadership.
• Meet department quality and production standards.
• Support initiatives to improve claims function efficiency.
• Complete basic claims projects as assigned.

Skills

Research & data analysis

Customer service

Organizational skills

Time management

Verbal & written communication

Microsoft Office

Tools

Claims processing software

Job description

Molina Healthcare is seeking a claims support professional in the United States (Kentucky) to assist with provider claims adjudication and issue resolution. You will address inquiries, analyze claims problems, and collaborate across departments to ensure timely, accurate resolutions.

The role emphasizes attention to detail, strong communication, and adherence to established quality standards, with opportunities to contribute to claims process improvements within a supportive team environment.