Job Details

Claims Adjudication Position

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

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.