Senior Claims Auditor & Investigator

Molina Healthcare; Florida; On-site; USD 21,000 - 40,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a senior claims examiner to provide high-level support for claims evaluation, adjudication, and investigation. You will manage diverse caseloads, procure supporting medical records, and recommend resolutions to prevent processing errors.

The role requires at least 2 years in claims, strong data-entry and analytical abilities, and proficiency with Microsoft Office. Competitive benefits are offered. This is an on-site position in Florida.

Qualifications

• At least 2 years of experience in claims, preferably in managed care.
• Strong research and data entry abilities.
• Excellent organizational and time-management skills.
• Effective verbal and written communication.
• Proficiency with Microsoft Office and relevant software.

Responsibilities

• Evaluates adjudication of claims using standard principles and state regulations.
• Manages a caseload of claims and procures medical records to support claims.
• Makes recommendations for further investigation or resolution of claims.
• Identifies errors in pre-payment adjudication and suggests solutions.
• Monitors medical treatment and keeps detailed records for each claim.
• Ensures compliance with federal and state turnaround times and payments.
• Meets department quality and production standards.
• Supports claims department efficiency initiatives.
• Completes assigned claims projects.

Skills

Research & data entry

Organizational skills

Time management

Verbal and written communication

Attention to detail

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a senior claims examiner to provide high-level support for claims evaluation, adjudication, and investigation. You will manage diverse caseloads, procure supporting medical records, and recommend resolutions to prevent processing errors.

The role requires at least 2 years in claims, strong data-entry and analytical abilities, and proficiency with Microsoft Office. Competitive benefits are offered. This is an on-site position in Florida.