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.
Examiner, Claims (Remote)
Molina Healthcare Long Beach, California; Owensboro, Kentucky; Sioux City, Iowa; Green Bay, Wisconsin; Provo, Utah; Ann Arbor, Michigan; Iowa City, Iowa; Vancouver, Washington; Houston, Texas; Everett, Washington; Nebraska; Mesa, Arizona; Louisville, Kentucky; Boise, Idaho; Savannah, Georgia; Tacoma, Washington; Davenport, Iowa; Idaho Falls, Idaho; Layton, Utah; Scottsdale, Arizona; Bellevue, Washington; Bellevue, Nebraska; Idaho; New Mexico; Ohio; Miami, Florida; Nampa, Idaho; St. Petersburg, Florida; Macon, Georgia; Austin, Texas; Washington; New York; Cleveland, Ohio; Madison, Wisconsin; Cedar Rapids, Iowa; Yonkers, New York; Milwaukee, Wisconsin; Racine, Wisconsin; Dayton, Ohio; Spokane, Washington; Texas; Orem, Utah; Buffalo, New York; Lexington-Fayette, Kentucky; Warren, Michigan; Columbus, Ohio; Akron, Ohio; Kentucky; Florida; Iowa; Santa Fe, New Mexico; Syracuse, New York; Meridian, Idaho; Kenosha, Wisconsin; Rio Rancho, New Mexico; Des Moines, Iowa; Columbus, Georgia; Augusta, Georgia; Atlanta, Georgia; Detroit, Michigan; Lincoln, Nebraska; Wisconsin; Michigan; Georgia; Las Cruces, New Mexico; Salt Lake City, Utah; Cincinnati, Ohio; Kearney, Nebraska; Caldwell, Idaho; Grand Island, Nebraska; Albany, New York; San Antonio, Texas; Utah; Albuquerque, New Mexico; Grand Rapids, Michigan; Dallas, Texas; Fort Worth, Texas; Roswell, New Mexico; Rochester, New York; Orlando, Florida; Jacksonville, Florida; Bowling Green, Kentucky; Phoenix, Arizona; Sterling Heights, Michigan; Chandler, Arizona; Tampa, Florida; Tucson, Arizona; West Valley City, Utah; Covington, Kentucky; Omaha, Nebraska Job ID 2033304JOB DESCRIPTION
Job Summary
Responsible for administering claims payments, maintaining claim records. 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
- Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.
- Manages a caseload of claims. Procures all medical records and statements that support the claim.
- Makes recommendations for further investigation or resolution.
- Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.
- Supports all department initiatives in improving overall efficiency.
- Meets department quality and production standards.
- Other duties as assigned.
JOB QUALIFICATIONS
Required Education
HS Diploma or GED
Required Experience
1-3 years
Preferred Education
Associate degree or equivalent combination of education and experience
Preferred Experience
3-5 years
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 - $31.71 / 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 08/25/2025Job Alerts
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