Manager, Claims (Portal Response)
Molina Healthcare Akron, Ohio; Albuquerque, New Mexico; Ann Arbor, Michigan; Atlanta, Georgia; Augusta, Georgia; Austin, Texas; Boise, Idaho; Bowling Green, Kentucky; Caldwell, Idaho; Cedar Rapids, Iowa; Chandler, Arizona; Cincinnati, Ohio; Columbus, Georgia; Cleveland, Ohio; Columbus, Ohio; Dallas, Texas; Covington, Kentucky; Davenport, Iowa; Dayton, Ohio; Houston, Texas; Texas; Macon, Georgia; Ohio; Omaha, Nebraska; Orlando, Florida; Phoenix, Arizona; San Antonio, Texas; Tampa, Florida; Tucson, Arizona; Scottsdale, Arizona; Tacoma, Washington; Orem, Utah; Everett, Washington; Grand Island, Nebraska; Lincoln, Nebraska; Madison, Wisconsin; Rio Rancho, New Mexico; Bellevue, Nebraska; Owensboro, Kentucky; Sterling Heights, Michigan; Salt Lake City, Utah; Roswell, New Mexico; Florida; Savannah, Georgia; Nampa, Idaho; Rochester, New York; Lexington-Fayette, Kentucky; Louisville, Kentucky; Spokane, Washington; Iowa City, Iowa; Idaho Falls, Idaho; New York; Washington; Fort Worth, Texas; Wisconsin; Las Cruces, New Mexico; Mesa, Arizona; Buffalo, New York; Milwaukee, Wisconsin; Idaho; Albany, New York; Sioux City, Iowa; Kentucky; New Mexico; Syracuse, New York; Vancouver, Washington; Utah; Santa Fe, New Mexico; West Valley City, Utah; Nebraska; Georgia; Detroit, Michigan; Yonkers, New York; Kenosha, Wisconsin; Racine, Wisconsin; Iowa; Grand Rapids, Michigan; Des Moines, Iowa; Miami, Florida; St. Petersburg, Florida; Green Bay, Wisconsin; Kearney, Nebraska; Jacksonville, Florida; Michigan; Provo, Utah; Layton, Utah; Warren, Michigan; Bellevue, Washington; Meridian, Idaho Job ID 2033017JOB DESCRIPTION
Job Summary
Responsible for administering claims payments, provider claims inquiries, reconsiderations, claims adjudication, and maintaining claim records for the Portal Response Team. Â Provides counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.
KNOWLEDGE/SKILLS/ABILITIES
- Manages and develops a team focused on meeting or exceeding established performance targets. Targets may be based upon plans, federal or state requirements as dictated.
- Proactively plans for daily priorities as well as responds to new priorities within the organization and opportunities assigned from upper management.
- Responsible for compiling and submitting daily, weekly, and monthly departmental reports to management.
- Acts as a technical expert in handling complaints and other escalated issues from internal and external customers.
- Supports claims performance improvement via participation in special claims initiatives.
- Participates in and support the development of strategies to meet business needs.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
5-7 years
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
7-9 years
QNXT and/or Salesforce
Preferred License, Certification, Association
- Certification in Training and Development preferred for manager overseeing Training unit
- Internal Audit Certification a plus for manager overseeing Regulatory Quality Audit unit
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $54,373.27 - $111,808.76 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 07/28/2025ABOUT OUR LOCATION
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