Senior Claims Examiner: Fraud, Coding & Recovery Expert

Molina Healthcare; United States; Remote; USD 60.000 - 85.000; Vollzeit

Benefits dieser Stelle

Competitive benefits

Zusammenfassung

Remote Jobs is seeking a Senior Claims Examiner to provide senior level support for claims examination activities, including evaluating adjudication to identify incorrect coding, abuse and fraudulent billing practices, waste, and processing errors.

The role emphasizes managing a caseload, procuring medical records, and making recommendations for investigation and resolution. Strong organizational, data entry, and MS Office skills are essential.

Qualifikationen

• 2+ years of experience in claims, preferably in a managed care setting.
• Strong research and data entry skills.
• Excellent organizational skills and attention to detail.
• Proven time-management abilities to handle multiple tasks and deadlines.
• Clear verbal and written communication skills.

Aufgaben

• Evaluate adjudication of claims using standard principles and regulations to identify incorrect coding, abuse, and fraudulent billing.
• Manage a caseload of claims and procure medical records and statements.
• Make recommendations for further investigation or resolution of claims.
• Identify and reduce defects related to pre-payment adjudication and suggest solutions.
• Monitor medical treatment of claimants and maintain meticulous notes for each claim.
• Meet state and federal regulatory turnaround times and claims payment standards across multiple lines of business.

Kenntnisse

Research and data entry

Organizational skills

Time-management

Verbal and written communication

MS Office proficiency

Tools

Microsoft Office

Jobbeschreibung

Remote Jobs is seeking a Senior Claims Examiner to provide senior level support for claims examination activities, including evaluating adjudication to identify incorrect coding, abuse and fraudulent billing practices, waste, and processing errors.

The role emphasizes managing a caseload, procuring medical records, and making recommendations for investigation and resolution. Strong organizational, data entry, and MS Office skills are essential.