<p>JOB DESCRIPTION</p> <p>Job Summary</p> <p>Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.</p> <p>Essential Job Duties</p> <ul> <li>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. </li><li>Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. </li><li>Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. </li><li>Assists in reviews of state and federal complaints related to claims. </li><li>Collaborates with other internal departments to determine appropriate resolution of claims issues. </li><li>Researches claims tracers, adjustments, and resubmissions of claims. </li><li>Adjudicates or readjudicates high volumes of claims in a timely manner. </li><li>Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. </li><li>Meets claims department quality and production standards. </li><li>Supports claims department initiatives to improve overall claims function efficiency. </li><li>Completes basic claims projects as assigned. </li></ul> <p>Required Qualifications</p> <ul> <li>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. </li><li>Research and data analysis skills. </li><li>Organizational skills and attention to detail. </li><li>Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. </li><li>Customer service experience. </li><li>Effective verbal and written communication skills. </li><li>Microsoft Office suite and applicable software programs proficiency. </li></ul> <p>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.</p> <p>Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p> <p>Pay Range: $21.16 - $38.37 / HOURLY</p> <ul> <li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. </li></ul> <p>About Us</p> <p>Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.</p>