• Manager, Claims (Portal Response)

    Molina Healthcare (Caldwell, ID)


    JOB DESCRIPTION

    Job Summary

    Responsible for administering claims payments, provider claims inquiries, reconsiderations, claims adjudication, and maintaining claim records for the Portal Response Team. Provides counsel to claimants regarding coverage amount and benefit interpretation. 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

    + Manages and develops a team focused on meeting or exceeding established performance targets. Targets may be based upon plans, federal or state requirements as dictated.

    + Proactively plans for daily priorities as well as responds to new priorities within the organization and opportunities assigned from upper management.

    + Responsible for compiling and submitting daily, weekly, and monthly departmental reports to management.

    + Acts as a technical expert in handling complaints and other escalated issues from internal and external customers.

    + Supports claims performance improvement via participation in special claims initiatives.

    + Participates in and support the development of strategies to meet business needs.

    JOB QUALIFICATIONS

    Required Education

    Bachelor's Degree or equivalent combination of education and experience

    Required Experience

    5-7 years

    Preferred Education

    Graduate Degree or equivalent combination of education and experience

    Preferred Experience

    7-9 years

     

    QNXT and/or Salesforce

    Preferred License, Certification, Association

    + Certification in Training and Development preferred for manager overseeing Training unit

    + Internal Audit Certification a plus for manager overseeing Regulatory Quality Audit unit

     

    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: $77,969 - $141,371 / ANNUAL

    *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.