Adjudicator, Provider Claims

Molina Healthcare • Mesa, AZ • 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: $21.65 - $38.37 / HOURLY

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

Similar Jobs

Accountant 1

State of Arizona • Phoenix, AZ • 3h ago

Finance, Accounting & Banking

Job No: 539774 Work Type: Full-time Location: PHOENIX Categories: Accounting/Auditing,Budget/Finance/Payroll DEPT OF HEALTH SERVICES The Arizona Department of Health Services promotes and protects the health of Arizona's...

3h ago

Go to Apply

Adjudicator, Provider Claims

Molina Healthcare • Phoenix, AZ • 3h 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...

3h ago

Go to Apply

Bank Agile Product Owner Senior - HELOC

USAA • Phoenix, AZ • 20h ago

Finance, Accounting & Banking

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community a...

20h ago

Go to Apply

Director, Bank Agile Product Management - HELOC

USAA • Phoenix, AZ • 20h ago

Finance, Accounting & Banking

20h ago

Go to Apply

Part-time Bookkeeper

Robert Half • Phoenix, AZ • 20h ago

Finance, Accounting & Banking

Description We are looking for a detail-oriented Full Charge Bookkeeper to support day-to-day accounting operations for a growing organization in Phoenix, Arizona. This part-time role is primarily remote, with an expecte...

20h ago

Go to Apply

Fair and Responsible Banking Risk Consultant

U.S. Bank • Tempe, AZ • 20h ago

Finance, Accounting & Banking

At U.S. Bank, we're on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed. We believe it tak...

20h ago

Go to Apply