Adjudicator, Provider Claims

Molina Healthcare • Dallas, TX • 3h ago

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.

Go to Apply

Managed Services Finance & Accounting - Financial Operations - Director

PwC • Dallas, TX • 12h ago

Finance, Accounting & Banking

12h ago

Go to Apply

Manager Accounting 2

Northrop Grumman • Irving, TX • 12h ago

Finance, Accounting & Banking

RELOCATION ASSISTANCE: No relocation assistance available CLEARANCE TYPE: None TRAVEL: Yes, 10% of the Time Description At Northrop Grumman, our employees have incredible opportunities to work on revolutionary systems th...

12h ago

Go to Apply

Manager Accounting 1

Northrop Grumman • Irving, TX • 12h ago

Finance, Accounting & Banking

12h ago

Go to Apply

Manager Accounting 3

Northrop Grumman • Irving, TX • 12h ago

Finance, Accounting & Banking

12h ago

Go to Apply

Regional Finance Coordinator

Terracon • Dallas, TX • 12h ago

Finance, Accounting & Banking

34257BR Service Line: Office Management/Administration Office Name: Dallas Job Description: General Responsibilities: Responsible for coordinating the accurate and timely project registration, billing, collection and pro...

12h 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.