Job description
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.
JOB QUALIFICATIONS
Required Education
High School or GED
Required Experience
3-5 years claims processing/adjudicating required
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
5-7 years claims processing/adjudicating preferred
Pay Range: $21-22/hr. (Non-Exempt)
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
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