Senior Provider Claims Adjudication Lead

Molina Healthcare; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

Molina Healthcare in the United States is seeking a lead-level Provider Claims Adjudicator to oversee adjudication activities, respond to providers with issue resolution, and drive accurate claim decisions.

You will coordinate workflow, manage escalations, and mentor staff while partnering with other teams to improve processes and provider satisfaction.

This role requires strong analytical and problem-solving skills, attention to detail, and a commitment to high-quality customer service.

Qualifications

• Minimum 3 years as a Provider Claims Adjudicator.
• Experience in claims adjusting and customer service.
• Strong problem solving, research and resolution abilities.

Responsibilities

• Coordinate workflow and staffing of day-to-day claims adjudication activities.
• Manage escalations within the claims department to closure.
• Perform daily claims troubleshooting to support provider claims.
• Lead quality improvement efforts to enhance claims processes.
• Provide provider claims expertise and training to staff.
• Identify trends and suggest improvements to claims quality.

Skills

Analytical skills

Problem solving

Attention to detail

Customer service

Research and resolution

Education

Associate’s Degree or equivalent

Bachelor’s Degree or equivalent

Job description

Molina Healthcare in the United States is seeking a lead-level Provider Claims Adjudicator to oversee adjudication activities, respond to providers with issue resolution, and drive accurate claim decisions.

You will coordinate workflow, manage escalations, and mentor staff while partnering with other teams to improve processes and provider satisfaction.

This role requires strong analytical and problem-solving skills, attention to detail, and a commitment to high-quality customer service.