Adjudicator, Provider Claims

JOB DESCRIPTION **Job Summary** 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.