Remote Provider Claims Adjudicator (Ohio Residents)

Molina Healthcare, Inc.; United States; A distancia; USD 50.000 - 70.000; Jornada completa

Descripción de la vacante

Molina Healthcare, Inc. is seeking a Provider Claims Adjudicator to work remotely, with residency in Ohio. You will handle live provider claim adjustments, eligibility updates, and COBs, mainly via inbound calls, collaborating with care teams to resolve issues.

This role emphasizes accuracy, customer service, and timely processing, with standard work hours and a focus on quality service. Training and benefits are provided.

Formación

• At least 2 years in a clerical role in a claims or customer service setting in a managed care environment.
• Research and data analysis skills.
• Strong organizational skills and attention to detail.
• Time-management skills to handle multiple tasks to meet deadlines.
• Customer service experience.
• Effective verbal and written communication.
• Proficiency with Microsoft Office and related software.

Responsabilidades

• Provides support for provider claims adjudication, addressing claim issues and researching resolutions.
• Supports resolution of provider claims issues, analyzing systems and coordinating with billing to resolve.
• Collaborates with enrollment, provider information management, benefits configuration and claims teams to address issues.
• Responds to incoming calls from providers regarding claims inquiries with excellent customer service.
• Assists in reviews of state and federal complaints related to claims.
• Collaborates with internal departments to determine appropriate resolution of claims issues.
• Researches claim tracers, adjustments, and resubmissions of claims.
• Adjudicates or readjudicates high volumes of claims in a timely manner.
• Identifies defect patterns and communicates potential solutions to leadership.
• Meets claims department quality and production standards.
• Supports initiatives to improve claims efficiency.
• Completes basic claims projects as assigned.

Conocimientos

Clerical experience

Research & data analysis

Organizational skills

Time-management

Customer service

Verbal & written communication

Microsoft Office proficiency

Herramientas

Salesforce

QNXT

PEGA

Claim Shark

Microsoft Office

Descripción del empleo

Molina Healthcare, Inc. is seeking a Provider Claims Adjudicator to work remotely, with residency in Ohio. You will handle live provider claim adjustments, eligibility updates, and COBs, mainly via inbound calls, collaborating with care teams to resolve issues.

This role emphasizes accuracy, customer service, and timely processing, with standard work hours and a focus on quality service. Training and benefits are provided.