Senior Claims Integrity Auditor

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

Benefits offered by this job

Benefits package

Job summary

Molina Healthcare is seeking a senior claims examination professional in Florida to evaluate adjudication, identify incorrect coding, abuse, fraud, and processing errors across multiple lines of business. You will manage caseloads, procure records, and recommend investigations or resolutions.

The role requires at least 2 years in claims or related customer service, strong data entry, organization, and communication skills, plus proficiency with Microsoft Office. Competitive benefits offered.

Qualifications

• At least 2 years of claims or customer service experience in a managed care setting.
• Research and data entry skills.
• Strong organizational, time-management, and attention to detail.
• Effective verbal and written communication skills.

Responsibilities

• Evaluates the adjudication of claims using standard principles and state regulations to identify incorrect coding, abuse, fraud, waste, overpayments, and processing errors.
• Manages a caseload of claims and procures all medical records and statements supporting the claim.
• Makes recommendations for further investigation and/or resolution of claims.
• Oversees reduction of defects by identifying error issues related to pre-payment adjudication and recommends solutions.
• Identifies and recommends solutions for error issues related to pre-payment of claims.
• Monitors the medical treatment of claimants and keeps meticulous notes for each claim.
• Manages diverse complex claims and procures necessary documentation.
• Meets state and federal regulatory compliance on turnaround times and claims payment for multiple lines of business.
• Meets department quality and production standards.
• Supports all claims department initiatives to improve efficiency.
• Completes claims projects as assigned.

Skills

Research and data entry

Organizational skills

Time-management

Customer service experience

Verbal and written communication

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a senior claims examination professional in Florida to evaluate adjudication, identify incorrect coding, abuse, fraud, and processing errors across multiple lines of business. You will manage caseloads, procure records, and recommend investigations or resolutions.

The role requires at least 2 years in claims or related customer service, strong data entry, organization, and communication skills, plus proficiency with Microsoft Office. Competitive benefits offered.