Remote Provider Claims Adjudicator – Ohio

Molina Healthcare, Inc.; Oregon; Hybrid; USD 48,000 - 64,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a Provider Claims Adjudicator to support provider claim inquiries, adjustments, and COBs. This remote role requires residing in Ohio and involves heavy inbound calls from providers, with standard business hours EST.

You will analyze claims, assist with eligibility updates, research issues, and collaborate with claims processing teams to ensure accurate resolution while delivering excellent service.

Qualifications

• 2+ years in clerical claims or customer service roles within managed care.
• Experience with provider claims investigation, research, and resolution.
• Strong data analysis, organization, and time-management abilities.
• Excellent verbal and written communication.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Respond to providers to address claim issues and research resolutions.
• Resolve provider claims issues including incorrect payments with cross-functional teams.
• Collaborate with enrollment, provider information, and benefits configuration teams.
• Handle high volumes of provider calls with excellent service and documentation.
• Review state and federal complaints related to claims.
• Research tracers, adjustments, and resubmissions.
• Adjudicate or readjudicate claims in a timely manner.
• Identify and communicate claims errors and improvement ideas to leadership.
• Strive to meet quality and production standards.
• Participate in claims initiatives to improve efficiency.
• Complete basic claims projects as assigned.

Skills

Data analysis

Organizational

Time management

Customer service

Communication

MS Office

Tools

Salesforce

QNXT

PEGA

Claim Shark

Job description

Molina Healthcare, Inc. is seeking a Provider Claims Adjudicator to support provider claim inquiries, adjustments, and COBs. This remote role requires residing in Ohio and involves heavy inbound calls from providers, with standard business hours EST.

You will analyze claims, assist with eligibility updates, research issues, and collaborate with claims processing teams to ensure accurate resolution while delivering excellent service.