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.
• 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
High School or GED
3-5 years claims processing required
Bachelor's Degree or equivalent combination of education and 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.
Apply on company website