Senior Claims Examiner: Detect & Resolve Billing Errors

Molina Healthcare; United States; On-site; USD 52,000 - 78,000; Full time

Job summary

Molina Healthcare is seeking a senior claims examiner to provide expert support in evaluating claim adjudication for accuracy, detecting fraud, and preventing overpayments. You will manage complex claim caseloads, procure records, and recommend investigations while ensuring compliance with regulatory standards.

The role emphasizes meticulous documentation, strong communication, and proficient use of Microsoft Office to support efficient, compliant claims processing.

Qualifications

• Research and data entry skills.
• Organizational skills and attention to detail.
• Time-management skills and ability to manage multiple projects.
• Customer service experience.
• Effective verbal and written communication skills.
• Microsoft Office suite proficiency.

Responsibilities

• Evaluates the adjudication of claims using standard principles and regulations to identify incorrect coding, abuse, and billing practices.
• Manages a caseload of claims and procures all medical records and statements that support the claim.
• Makes recommendations for further investigation and resolution of claims.
• Oversees reduction of defects by identifying error issues related to pre-payment and suggests solutions.
• Monitors the medical treatment of claimants and keeps meticulous notes for each claim.
• Meets state and federal regulatory compliance on turnaround times and claims payment for multiple lines of business.

Skills

Research and data entry

Organizational skills

Time management

Customer service

Verbal and written communication

Microsoft Office proficiency

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a senior claims examiner to provide expert support in evaluating claim adjudication for accuracy, detecting fraud, and preventing overpayments. You will manage complex claim caseloads, procure records, and recommend investigations while ensuring compliance with regulatory standards.

The role emphasizes meticulous documentation, strong communication, and proficient use of Microsoft Office to support efficient, compliant claims processing.