Adjudicator, Provider Claims-Ohio-On the Phone

Molina Healthcare • Orem, UT • 2h 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

Adjudicator, Provider Claims-Ohio-On the Phone

Molina Healthcare • Provo, UT • 2h ago

Finance, Accounting & Banking

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. Th...

2h ago

Go to Apply

Administrative Assistant - International Tax

Eide Bailly • Lehi, UT • 9h ago

Finance, Accounting & Banking

Location: Any Eide Bailly office location Work Arrangement: In-office, Hybrid, or Remote The Administrative Assistant - International Tax provides essential support to the international tax team by managing tax filings,...

9h ago

Go to Apply

Accounts Receivable Specialist

Robert Half • Provo, UT • 1d ago

Finance, Accounting & Banking

Description We are seeking a detail-oriented and proactive Accounts Receivable Specialist to join our finance team. This role is responsible for managing customer accounts, ensuring timely collection of payments, and mai...

1d ago

Go to Apply

Accounts Payable Clerk

Robert Half • Sandy, UT • 1d ago

Finance, Accounting & Banking

Description We are seeking a reliable and detail-oriented Accounts Payable Clerk to join our finance team. This role is responsible for processing vendor invoices, ensuring timely payments, and maintaining accurate finan...

1d ago

Go to Apply

Adjudicator, Provider Claims

Molina Healthcare • Provo, UT • 1d ago

Finance, Accounting & Banking

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 cl...

1d ago

Go to Apply

Adjudicator, Provider Claims

Molina Healthcare • Orem, UT • 1d ago

Finance, Accounting & Banking

1d ago

Go to Apply

Staff Accountant

Robert Half • Highland, UT • 1d ago

Finance, Accounting & Banking

Description We are looking for a detail-oriented and motivated Staff Accountant to join our finance team. This role is responsible for maintaining accurate financial records, assisting with month-end close, and supportin...

1d ago

Go to Apply

Accounting Clerk

Robert Half • Pleasant Grove, UT • 1d ago

Finance, Accounting & Banking

Description The Accounting Clerk is responsible for providing support to the finance department by performing a variety of accounting and administrative tasks. This role ensures accurate financial record-keeping, timely...

1d ago

Go to Apply

SVP, Digital Finance - Amazon

Synchrony • Draper, UT • 1d ago

Finance, Accounting & Banking

Job Description: Role Summary/Purpose: The SVP, Digital Finance - Amazon will provide strategic and operational financial leadership to our Amazon portfolio. The role reports directly to CFO of the Digital platform and w...

1d ago

Go to Apply

SVP, Digital Finance - Amazon

Synchrony • Draper, UT • 1d ago

Finance, Accounting & Banking

1d 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.