Remote Provider Claims Adjudicator – Ohio

Molina Healthcare, Inc.; New York (NY); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare, Inc. is hiring a Provider Claims Adjudicator to support provider claims adjudication activities, including live adjustments, eligibility updates, and COBs. This is a remote role with the requirement that candidates reside in Ohio.

The position focuses on handling high volumes of inbound calls from providers and delivering accurate, timely resolutions. Ideal candidates have experience in managed care claims, call center claims, and familiarity with claims systems such as

Qualifications

• 2+ years in clerical claims or customer service within managed care, with provider claims investigation/resolution experience.
• Strong research and data analysis skills.
• Excellent organizational skills and attention to detail.
• Effective verbal and written communication skills.
• Proficiency in Microsoft Office and related software.

Responsibilities

• Provide support for provider claims adjudication, addressing claim issues and researching resolutions.
• Analyze provider claims issues and coordinate with billing/operational teams to resolve them.
• Collaborate with enrollment, benefits, and claims processing teams on provider claim issues.
• Handle incoming provider inquiries via calls with strong customer service and documentation.
• Assist in reviews of state and federal complaints related to claims.
• Coordinate with internal departments to determine resolution of claims issues.
• Review tracers, adjustments, and resubmissions of claims.
• Adjudicate or readjudicate high volumes of claims promptly.
• Support claims department initiatives to improve efficiency.

Skills

Research & Data Analysis

Customer service

Verbal & Written communication

Time management

MS Office

Tools

Salesforce

Qnxt

PEGA

Claim Shark

Job description

Molina Healthcare, Inc. is hiring a Provider Claims Adjudicator to support provider claims adjudication activities, including live adjustments, eligibility updates, and COBs. This is a remote role with the requirement that candidates reside in Ohio.

The position focuses on handling high volumes of inbound calls from providers and delivering accurate, timely resolutions. Ideal candidates have experience in managed care claims, call center claims, and familiarity with claims systems such as