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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.

+ 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.