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.
• Other duties as assigned.

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

QNXT, Workflow and Salesforce

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: $14.9 - $29.06 / 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.