Senior Provider Claims Adjudicator (Remote Lead)

NEPSE Trading; Northern (KY); Hybrid; USD 85.000 - 110.000; Vollzeit

Zusammenfassung

Molina Healthcare is seeking a Lead Adjudicator for Provider Claims. This remote, full-time role supervises adjudication activities, resolves complex provider claims, and drives process improvements while ensuring quality and productivity standards.

The candidate will serve as a claims SME, mentor staff, and coordinate cross-functional problem-solving to meet service levels and compliance requirements.

Qualifikationen

• Associate’s degree or equivalent combination of education and experience.
• Bachelor’s degree preferred.
• Minimum 3 years as a Provider Claims Adjudicator; 6+ years preferred.

Aufgaben

• Lead day-to-day claims adjudication activities and supervise staff.
• Coordinate workflow, assign and monitor work to meet standards.
• Handle escalations with accountability and timely follow-through.
• Provide training and feedback to the claims team as needed.
• Analyze claims data to improve processes and provider satisfaction.
• Collaborate with stakeholders to resolve provider claims issues.

Kenntnisse

Problem solving

Critical thinking

Research & resolution

Attention to detail

Analytical skills

Customer service

Ausbildung

Associate's degree

Bachelor's degree

Jobbeschreibung

Molina Healthcare is seeking a Lead Adjudicator for Provider Claims. This remote, full-time role supervises adjudication activities, resolves complex provider claims, and drives process improvements while ensuring quality and productivity standards.

The candidate will serve as a claims SME, mentor staff, and coordinate cross-functional problem-solving to meet service levels and compliance requirements.