Adjudicator, Provider Claims (must reside in Kentucky)

Molina Healthcare • Adairville, KY • 6d 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: $15.58 - $31.97 / HOURLY

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

Similar Jobs

Adjudicator, Provider Claims-KY-On the phone-closing shift

Molina Healthcare • Adairville, KY • 1w 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...

1w ago

Go to Apply

Same Day Surgery Nurse

HCA Healthcare • Springfield, TN • 1h ago

Hospital & Medical

Ready for a role that supports your unique calling in patient care and fits your life? At TriStar NorthCrest Medical Center, you'll find clear pathways to advance backed by our unmatched nationwide transfer policy that l...

1h ago

Go to Apply

Guest Services Leader

Pilot Company • Franklin, KY • 1h ago

Retail & Hospitality

Company Description Pilot Company is an industry-leading network of travel centers with more than 30,000 team members and over 750 retail and fueling locations in 44 states and six Canadian provinces. Our energy and logi...

1h ago

Go to Apply

Retail Sales Associate

Ollie's Bargain Outlet • Springfield, TN • 1d ago

Retail & Hospitality

Description Join our team and live the Ollie-tude!: (Ollie's Core Values) BE A TEAM PLAYER- Associates are expected to be supportive and work together. BE CARING- How do I treat others with courtesy, dignity, and respect...

1d ago

Go to Apply

Customer Service Associate - Temporary

Walgreens • Springfield, TN • 2d ago

Management & Administrative

Job Description: Models and delivers a distinctive and delightful customer experience. Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service. Custome...

2d ago

Go to Apply

Truck Driver on-the-job CDL Training

Roehl Transport • Russellville, KY • 3d ago

Trucking & Construction

Make more of yourself and for yourself. If you qualify, Roehl Transport will pay you to get your CDL (https:www.roehl.jobs/driving-jobs/cdl-truck-driving-schools) & earn a great living as a truck driver. If you are c...

3d ago

Go to Apply

Quality Electrical Test Lead

Actalent • Portland, TN • 3d ago

IT & Engineering

Quality Electrical Test Lead Job Description This role will guide a team of technicians responsible for functional testing, troubleshooting, quality checks, and performance verification of BESS units prior to deployment....

3d ago

Go to Apply

Registered Nurse (RN)

Signature Healthcare • Portland, TN • 4d ago

Hospital & Medical

About Us Signature HealthCARE of Portland Rehab & Wellness Center is a 112-bed long term care/rehab-to-home facility located in Portland, TN. Signature HealthCARE of Portland provides comprehensive behavioral service...

4d ago

Go to Apply

Entry Level R&D Mechanical Engineer

Actalent • Portland, TN • 4d ago

IT & Engineering

Mechanical Engineer Job Description We are seeking a hands-on, curious, and proactive R&D Mechanical Engineer to join our team in developing specialized machine guarding solutions for industrial customers. This role...

4d ago

Go to Apply

Truck Driver on-the-job CDL Training

Roehl Transport • Rockfield, KY • 4d ago

Trucking & Construction

4d ago

Go to Apply

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