Remote Provider Claims Adjudicator – Ohio

Molina Healthcare, Inc.; Ohio; À distance; USD 23 000 - 44 000; Plein temps

Résumé du poste

Molina Healthcare, Inc. is hiring a Provider Claims Adjudicator. This remote role requires the candidate to reside in Ohio and handle live provider calls to adjudicate and adjust claims.

Responsibilities include researching issues, resolving mispaid claims, and coordinating with billing and provider teams. The role emphasizes customer service and accurate documentation in a fast-paced environment.

Qualifications

• 2+ years in a claims, customer service, or clerical role within a managed care org.
• Strong research and data analysis skills.
• Excellent organizational, time-management, and detail orientation.

Responsabilités

• Respond to provider inquiries and resolve claim issues; document interactions.
• Analyze mispaid claims and coordinate with billing teams for resolution.
• Collaborate with enrollment, benefits, and claims teams to address issues.
• Adjudicate high volumes of claims promptly and meet quality standards.
• Support in reviews of state and federal complaints related to claims.
• Identify defect trends and communicate solutions to leadership.

Connaissances

MCO claims

Call center

Billing appeals

Provider service

Salesforce

QNXT

PEGA

Claim Shark

Outils

Salesforce

QNXT

PEGA

Description du poste

Molina Healthcare, Inc. is hiring a Provider Claims Adjudicator. This remote role requires the candidate to reside in Ohio and handle live provider calls to adjudicate and adjust claims.

Responsibilities include researching issues, resolving mispaid claims, and coordinating with billing and provider teams. The role emphasizes customer service and accurate documentation in a fast-paced environment.