Senior Examiner, Claims (Remote) - Molina Healthcare : Job Details

JOB DESCRIPTION

Job Summary

Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Meets and consistently maintains production standards for Claims Adjudication.

• Supports all department initiatives in improving overall efficiency.

• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.

• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues.

• Monitors the medical treatment of claimants. Keeps meticulous notes and records for each claim.

• Manages a caseload of various types of complex claims. Procures all medical records and statements that support the claim.

• Meets department quality and production standards.

• Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business.

• Other duties as assigned.

• QNXT-preferred

JOB QUALIFICATIONS

Required Education

High School or GED

Required Experience

3-5 years claims processing required

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5-7 years claims processing preferred

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 - $34.88 / HOURLY

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