Adjudicator, Provider Claims (On the Phones, Must Reside in OH)

Molina Healthcare • Columbus, OH • 3d ago

Job Description

Job Summary

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.

Knowledge/Skills/Abilities

Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.

This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing.

Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.

Assists in the reviews of state or federal complaints related to claims.

Supports the other team members with several internal departments to determine appropriate resolution of issues.

Researches tracers, adjustments, and re-submissions of claims.

Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.

Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.

Handles special projects as assigned.

Other duties as assigned.

Knowledgeable in systems utilized:

QNXT

Pega

Verint

Kronos

Microsoft Teams

Video Conferencing

Others as required by line of business or state

Job Function

Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators.

Job Qualifications

REQUIRED EDUCATION:

Associate's Degree or equivalent combination of education and experience;

REQUIRED EXPERIENCE:

2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems.

1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry

PREFERRED EDUCATION:

Bachelor's Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

4 years

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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: $21.16 - $38.37 / HOURLY

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

Similar Jobs

Accounting and Audit Internship

Cardinal Health • Dublin, OH • 59min ago

Finance, Accounting & Banking

Summer Internship Program Overview Cardinal Health's Summer Internship Program is a structured 10-12 week experience designed for undergraduate students who will be entering their senior year and are eager to make an imp...

59min ago

Go to Apply

Accounts Payable Analyst

Aston Carter • Dublin, OH • 5h ago

Finance, Accounting & Banking

Accounts Payable Specialist Job Summary: The Accounts Payable Specialist is responsible for managing and processing the company's outgoing payments. This role ensures that all invoices are accurately recorded, approved,...

5h ago

Go to Apply

Finance Internship

Cardinal Health • Dublin, OH • 6h ago

Finance, Accounting & Banking

6h ago

Go to Apply

Principal Financal Analyst, Product Finance Deals

Oracle • Columbus, OH • 6h ago

Finance, Accounting & Banking

Job Description Oracle Cloud Infrastructure (OCI) is one of the fasting growing businesses for the company. In OCI Finance, members of the Workload Health Product team are responsible for all aspects of cloud infrastruct...

6h ago

Go to Apply

Associate Director - Corporate Mortgage Finance PM

Huntington National Bank • Columbus, OH • 6h ago

Finance, Accounting & Banking

Description As an Associate Director - Corporate Mortgage Finance Group Portfolio Manager, you will be responsible for underwriting CMF Lending facilities, assisting with legal documentation reviews as well as monitoring...

6h ago

Go to Apply

Finance Data Analyst Senior

Intermountain Health • Columbus, OH • 6h ago

Finance, Accounting & Banking

Job Description: This position is involved in budgeting, strategic planning, variance, patient account and operations data, and ad-hoc analysis processes, which are used to ensure sound financial operations and producing...

6h ago

Go to Apply

Accounting Manager

Norstella • Columbus, OH • 10h ago

Finance, Accounting & Banking

Accounting Manager Company: Norstella Location: Remote, United States Date Posted: Sep 2, 2025 Employment Type: Full Time Job ID: R-1460 Description About Norstella At Norstella, our mission is simple: to help our client...

10h ago

Go to Apply

Financial Center Manager Associate

Fifth Third Bank, N.A. • Columbus, OH • 21h ago

Finance, Accounting & Banking

Make banking a Fifth Third better® We connect great people to great opportunities. Are you ready to take the next step? Discover a career in banking at Fifth Third Bank. GENERAL FUNCTION:The Financial Center Manager will...

21h ago

Go to Apply

Financial Center Manager Associate

Fifth Third Bank, N.A. • Powell, OH • 21h ago

Finance, Accounting & Banking

21h ago

Go to Apply

Executive Office Specialist III - Home Lending

JPMorgan Chase • Columbus, OH • 2d ago

Finance, Accounting & Banking

Join the team that supports Home Lending to do the right thing for our customers. If you are detail-oriented, have great oral and written communication skills and can work in a fast-paced environment, this executive offi...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.