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Sr Examiner, Claims

Long Beach, California Job ID 1902959
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Job 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
• Meets and consistently maintains production standards for Claims Adjudication.
• Supports all department initiatives in improving overall efficiency.
• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.
• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and  recommending solutions to resolve these issues.
• Monitors the medical treatment of claimants.  Keeps meticulous notes and records for each claim.
• Manages a caseload of various types of complex claims. Procures all medical records and statements that support the claim.
• Meets department quality and production standards.
• Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business

Qualifications

Job Qualifications



Required Education
High School or GED
Required Experience
3-5 years claims processing required
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
5-7 years claims processing preferred

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.

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