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Adjudicator, Provider Claims-On The Phone (Remote)
Molina HealthcareKY, United States; Kentucky; Nebraska; Lincoln, Nebraska; West Valley City, Utah; Bowling Green, Kentucky; Wisconsin; Miami, Florida; Warren, Michigan; Cincinnati, Ohio; Sioux City, Iowa; Phoenix, Arizona; Orem, Utah; Augusta, Georgia; Idaho Falls, Idaho; Provo, Utah; Fort Worth, Texas; Roswell, New Mexico; Arizona; St. Petersburg, Florida; Vancouver, Washington; Sterling Heights, Michigan; Kenosha, Wisconsin; Grand Island, Nebraska; Caldwell, Idaho; Grand Rapids, Michigan; Dayton, Ohio; Albany, New York; Utah; Florida; Nampa, Idaho; Milwaukee, Wisconsin; Scottsdale, Arizona; Yonkers, New York; Rio Rancho, New Mexico; Tacoma, Washington; Santa Fe, New Mexico; Cedar Rapids, Iowa; Macon, Georgia; Dallas, Texas; Savannah, Georgia; Las Cruces, New Mexico; Covington, Kentucky; Iowa; Tampa, Florida; Albuquerque, New Mexico; Iowa City, Iowa; Houston, Texas; Mesa, Arizona; Michigan; Orlando, Florida; Akron, Ohio; Columbus, Georgia; New York; Salt Lake City, Utah; Ohio; Austin, Texas; Kearney, Nebraska; Atlanta, Georgia; New Mexico; Des Moines, Iowa; Spokane, Washington; Everett, Washington; Idaho; Davenport, Iowa; Jacksonville, Florida; Madison, Wisconsin; Georgia; Buffalo, New York; Lexington-Fayette, Kentucky; Washington; Bellevue, Nebraska; Rochester, New York; Meridian, Idaho; Bellevue, Washington; Owensboro, Kentucky; Racine, Wisconsin; Layton, Utah; Chandler, Arizona; Tucson, Arizona; Detroit, Michigan; Omaha, Nebraska; Louisville, Kentucky; Green Bay, Wisconsin; Columbus, Ohio; San Antonio, Texas; Cleveland, Ohio; Syracuse, New York; Ann Arbor, Michigan; Texas; Boise, Idaho Job ID 2034787
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.
Essential Job Duties
• Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution.
• Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues.
• Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.
• Assists in reviews of state and federal complaints related to claims.
• Collaborates with other internal departments to determine appropriate resolution of claims issues.
• Researches claims tracers, adjustments, and resubmissions of claims.
• Adjudicates or readjudicates high volumes of claims in a timely manner.
• Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
• Meets claims department quality and production standards.
• Supports claims department initiatives to improve overall claims function efficiency.
• Completes basic claims projects as assigned.
Required Qualifications
• At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience.
• Research and data analysis skills.
• Organizational skills and attention to detail.
•Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Customer service experience.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
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 - $38.37 / 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 11/11/2025Job Alerts
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