Senior Claims Examiner & Adjudication Specialist

Molina Talent Acquisition; Florida; On-site; USD 42,000 - 62,000; Full time

Job summary

Molina Healthcare is seeking a claims examiner to provide senior support in evaluating adjudication of claims, identifying coding issues, abuse and fraudulent billing, and resolution of processing errors. The role involves procuring medical records, maintaining detailed notes, and ensuring regulatory compliance across multiple lines of business.

Qualifications include 2+ years in claims or clerical roles, strong data entry and communication skills, and proficiency with the Microsoft Office

Qualifications

• 2+ years of experience in claims or clerical role, preferably in managed care.
• Demonstrated research and data entry skills.
• Strong organizational skills and attention to detail.
• Proven time-management to handle multiple tasks and deadlines.
• Customer service experience is required.
• Effective verbal and written communication skills.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Evaluate adjudication of claims using standard principles and regulations to identify issues.
• Procure all medical records and statements to support a claim.
• Recommend investigations and resolutions for claims.
• Oversee reduction of defects related to pre-payment adjudication and suggest solutions.
• Monitor medical treatment and maintain meticulous records for each claim.
• Manage a caseload of complex claims and related documentation.
• Ensure compliance with state and federal turnaround times and payment regulations.
• Support claims department initiatives to improve efficiency and complete assigned projects.

Skills

Research

Data entry

Organizational skills

Time management

Customer service

Communication skills

Microsoft Office

Tools

Microsoft Office Suite

Job description

Molina Healthcare is seeking a claims examiner to provide senior support in evaluating adjudication of claims, identifying coding issues, abuse and fraudulent billing, and resolution of processing errors. The role involves procuring medical records, maintaining detailed notes, and ensuring regulatory compliance across multiple lines of business.

Qualifications include 2+ years in claims or clerical roles, strong data entry and communication skills, and proficiency with the Microsoft Office