Remote Lead: Claims Appeals & Grievances

Molina Healthcare; United States; Remote; USD 65,000 - 105,000; Full time

Benefits offered by this job

Competitive benefits

Equal Opportunity Employer

Job summary

Molina Healthcare is seeking a lead-level claims support professional to supervise review and resolution of member and provider complaints in compliance with CMS standards. You will coordinate appeals and grievances, guide team members, and ensure accurate documentation and timely responses.

The role requires 3+ years in managed care claims or appeals, strong customer service, and proficiency with Microsoft Office and claims systems. Equal Opportunity Employer.

Qualifications

• 3+ years in managed care claims or appeals environment.
• Experience with Medicaid/Medicare claims denials and appeals.
• Strong customer service and communication skills.

Responsibilities

• Lead team in submission, intervention and resolution of appeals and grievances.
• Train new employees and guide complex cases.
• Prepare summaries, narratives, and documentation for audits.
• Ensure timely responses per CMS guidelines.
• Monitor performance against production standards.

Skills

Managed care experience

Call center experience

Claims processing

Regulatory knowledge CMS

Customer service

Verbal and written communication

Tools

Microsoft Office

Claims processing systems

Job description

Molina Healthcare is seeking a lead-level claims support professional to supervise review and resolution of member and provider complaints in compliance with CMS standards. You will coordinate appeals and grievances, guide team members, and ensure accurate documentation and timely responses.

The role requires 3+ years in managed care claims or appeals, strong customer service, and proficiency with Microsoft Office and claims systems. Equal Opportunity Employer.