ATTENTION JOB SEEKERS AND MOLINA APPLICANTS: FRAUD ALERT
Be aware that third parties posing as Molina Healthcare may be soliciting money from job seekers and extending offers to candidates who have not interviewed. Molina does not engage in these type of practices. If you have received an offer and have not been engaging with Molina Healthcare in an interview process, reach out to erc@molinahealthcare.com to validate the legitimacy of your offer. Please note that Molina has reported this activity to the appropriate law enforcement agencies for further investigation. If you feel you’ve been victimized, please report it to local law enforcement.
Associate Specialist, Appeals & Grievances
Molina Healthcare Everett, Washington; Syracuse, New York; Madison, Wisconsin; Grand Rapids, Michigan; Kearney, Nebraska; Cedar Rapids, Iowa; Sterling Heights, Michigan; Nampa, Idaho; Tacoma, Washington; Washington; Orem, Utah; Bellevue, Washington; Boise, Idaho; West Valley City, Utah; Racine, Wisconsin; Vancouver, Washington; Florida; Akron, Ohio; Tampa, Florida; Bowling Green, Kentucky; Buffalo, New York; Owensboro, Kentucky; Georgia; Phoenix, Arizona; Columbus, Ohio; Santa Fe, New Mexico; Las Cruces, New Mexico; Augusta, Georgia; Caldwell, Idaho; Lincoln, Nebraska; St. Petersburg, Florida; Atlanta, Georgia; Orlando, Florida; Kentucky; Warren, Michigan; San Antonio, Texas; Spokane, Washington; Roswell, New Mexico; Salt Lake City, Utah; Green Bay, Wisconsin; Miami, Florida; Omaha, Nebraska; Grand Island, Nebraska; Idaho Falls, Idaho; Wisconsin; Michigan; Ohio; Dayton, Ohio; Chandler, Arizona; Cincinnati, Ohio; Jacksonville, Florida; Fort Worth, Texas; Lexington-Fayette, Kentucky; Savannah, Georgia; Davenport, Iowa; Yonkers, New York; Macon, Georgia; Iowa; Utah; Texas; Mesa, Arizona; Layton, Utah; Rio Rancho, New Mexico; Albuquerque, New Mexico; Rochester, New York; Austin, Texas; Sioux City, Iowa; Covington, Kentucky; Ann Arbor, Michigan; Milwaukee, Wisconsin; Meridian, Idaho; Cleveland, Ohio; Tucson, Arizona; Kenosha, Wisconsin; Detroit, Michigan; Provo, Utah; Idaho; New Mexico; Nebraska; Iowa City, Iowa; New York; Louisville, Kentucky; Des Moines, Iowa; Columbus, Georgia; Albany, New York; Bellevue, Nebraska; Scottsdale, Arizona; Houston, Texas; Dallas, Texas Job ID 2032958JOB DESCRIPTION
Job Summary
Responsible for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized) representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.
KNOWLEDGE/SKILLS/ABILITIES
- Enters denials and requests for appeal into information system and prepares documentation for further review.
- Research issues utilizing systems and other available resources.
- Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines.
- Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.
- Determines appropriate language for letters and prepare responses to appeals and grievances.
- Elevates appropriate appeals to the Appeals Specialist.
- Generates and mails denial letters.
- Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.
- Creates and/or maintains statistics and reporting.
- Works with provider & member services to resolve balance bill issues and other member/provider complaints.
JOB QUALIFICATIONS
REQUIRED EDUCATION:
High School Diploma or equivalency
REQUIRED EXPERIENCE:
- 1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed care or healthcare environment.
- Strong verbal and written communication skills.
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: $21.16 - $34.88 / HOURLY
*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 08/05/2025Job Alerts
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