2024-04-22
Molina Healthcare (https://careers.molinahealthcare.com/)
Other
/yr
full-time
employee
United States
Job Description
Job Summary
The Sr. Provider Claims Adjudicator is responsible for responding to providers regarding complex issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require extensive experience to provide counsel to Provider Adjudicators and lead the work related to research and analytical work related to adjusting complex claims. Requires knowledge of multiple operational areas and systems.
Knowledge/Skills/Abilities
Knowledgeable in systems utilized:
Job Function
Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators.
Job Qualifications
REQUIRED EDUCATION:
Associate’s Degree or equivalent combination of education and experience
REQUIRED EXPERIENCE:
4-5 years customer service, claims, provider experience. Leadership skills, process improvement, innovation and investigation/research. Outcome focused and knowledge of multiple systems.
2+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
PREFERRED EDUCATION:
Bachelor’s Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
5-7 years
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home and office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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: $16.23 - $35.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.