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Examiner, Claims

Troy, Michigan Job ID 1903538
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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
• 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.

Qualifications

Job Qualifications



Required Education
HS Diploma or GED
Required Experience
1-3 years
Preferred Education
Associate's 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.

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