Adjudicator, Provider Claims (Must Reside in Ohio)

Molina Healthcare • Georgia, Georgia • 8h 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

DHS/DFCS Billings Specialist 1 - 00017188

State of Georgia • Georgia, Georgia • 11h ago

Finance, Accounting & Banking

DHS/DFCS Billings Specialist 1 - 00017188 ?? Georgia - Glynn - Brunswick ( https://ga.referrals.selectminds.com/jobs/73657/other-jobs-matching/location-only ) New ?? ( https://ga.referrals.selectminds.com/landingpages/fi...

11h ago

Go to Apply

Staff Accountant

Robert Half • Georgia, Georgia • 14h ago

Finance, Accounting & Banking

Description We are looking for a meticulous Staff Accountant to join our team in Georgia. In this long-term contract position, you will play a critical role in managing financial records, ensuring compliance with account...

14h ago

Go to Apply

Financial Operations Analyst

State of Georgia • Georgia, Georgia • 1d ago

Finance, Accounting & Banking

Financial Operations Analyst ?? Georgia - Dekalb - Atlanta ( https://ga.referrals.selectminds.com/jobs/73630/other-jobs-matching/location-only ) New ?? ( https://ga.referrals.selectminds.com/landingpages/regulatory-oppor...

1d ago

Go to Apply

UI Claims Examiner Associate - TLB

State of Georgia • Georgia, Georgia • 1d ago

Finance, Accounting & Banking

UI Claims Examiner Associate - TLB ?? Georgia - Fulton - Atlanta ( https://ga.referrals.selectminds.com/jobs/73616/other-jobs-matching/location-only ) New Hot ?? Regulatory ?? Labor, Georgia Department of - GDOL ?? ? ? ?...

1d ago

Go to Apply

Product & Segment Marketing Manager-Insurance

Seek Now • Georgia, Georgia • 3d ago

Finance, Accounting & Banking

SeekNow is transforming how insurance carriers see, assess, and act on property data. As we expand our technology and services platform, we're seeking a Manager, Product & Segment Marketing - Insurance to lead the go...

3d ago

Go to Apply

Program Manager, Enrollment Accounting

Molina Healthcare • Georgia, Georgia • 3d ago

Finance, Accounting & Banking

JOB DESCRIPTION Job Summary Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion....

3d ago

Go to Apply

Financial Aid Specialist - State Aid (Full-Time)

State of Georgia • Georgia, Georgia • 5d ago

Finance, Accounting & Banking

Financial Aid Specialist - State Aid (Full-Time) ?? Georgia - Fulton - Atlanta ( https://ga.referrals.selectminds.com/jobs/73522/other-jobs-matching/location-only ) New ?? ( https://ga.referrals.selectminds.com/landingpa...

5d ago

Go to Apply

Financial Aid Technician (Full-Time)

State of Georgia • Georgia, Georgia • 5d ago

Finance, Accounting & Banking

Financial Aid Technician (Full-Time) ?? Georgia - Fulton - Atlanta ( https://ga.referrals.selectminds.com/jobs/73524/other-jobs-matching/location-only ) New ?? ( https://ga.referrals.selectminds.com/landingpages/educatio...

5d ago

Go to Apply

DHS/DFCS Billings Specialist 1 - 00018717

State of Georgia • Georgia, Georgia • 6d ago

Finance, Accounting & Banking

DHS/DFCS Billings Specialist 1 - 00018717 ?? Georgia - Early - Blakely ( https://ga.referrals.selectminds.com/jobs/73462/other-jobs-matching/location-only ) New ?? ( https://ga.referrals.selectminds.com/landingpages/fina...

6d ago

Go to Apply

Admin Support 3 - Finance Department

State of Georgia • Georgia, Georgia • 6d ago

Finance, Accounting & Banking

Admin Support 3 - Finance Department ?? Georgia - Richmond - Augusta ( https://ga.referrals.selectminds.com/jobs/73452/other-jobs-matching/location-only ) New ?? ( https://ga.referrals.selectminds.com/landingpages/admini...

6d 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.