Adjudicator, Provider Claims

divh2Job Description/h2pProvides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims in a call center environment. Essential job duties include:/pulliRespond to inbound calls to provide support for provider claims adjudication activities including responding to provider to address claim issues, and researching, investigating and ensuring appropriate resolution of claims./liliResponds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions./liliProvides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution./liliCollaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues./liliAssists in reviews of state and federal complaints related to claims./liliCollaborates with other internal departments to determine appropriate resolution of claims issues./liliResearches claims tracers, adjustments, and resubmissions of claims./liliAdjudicates or re-adjudicates high volumes of claims in a timely manner./liliManages defect reduction by identifying and communicating claims error issues and potential solutions to leadership./liliMeets claims department quality and production standards./liliSupports claims department initiatives to improve overall claims function efficiency./liliCompletes basic claims projects as assigned./li/ulpRequired qualifications include:/pulliAt 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./liliResearch and data analysis skills./liliOrganizational skills and attention to detail./liliTime-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines./liliCustomer service experience./liliEffective verbal and written communication skills./liliMicrosoft Office suite and applicable software programs proficiency./li/ulpMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V./ppPay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level./p/div