Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors.
Essential Job Duties
• Evaluates the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.
• Manages a caseload of claims - procures all medical records and statements that support the claim.
• Makes recommendations for further investigation and/or resolution of claims.
• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication, and recommends solutions to resolve issues.
• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.
• 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 state and federal regulatory compliance regulations on turnaround times and claims payment for multiple lines of business (LOBs).
• Meets department quality and production standards.
• Supports all claims department initiatives to improve overall efficiency.
• Completes claims projects as assigned.
Required Qualifications
• At least 2 years of experience in claims, and/or customer service experience in a clerical role - preferably in a managed care setting, or equivalent combination of relevant education and experience.
• Research and data entry skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Customer service experience.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
• Health care claims/billing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Skills Required
- At least 2 years of claims or clerical customer service experience, preferably in a managed care setting, or equivalent education and experience
- Research and data entry skills
- Organizational skills and attention to detail
- Time-management skills and ability to manage simultaneous projects and tasks
- Customer service experience
- Effective verbal and written communication skills
- Proficiency with Microsoft Office and applicable software programs
- Healthcare claims or billing experience
Molina Healthcare Inc. Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Molina Healthcare Inc. and has not been reviewed or approved by Molina Healthcare Inc..
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Healthcare Strength — Health coverage is described as solid, including medical, dental, and vision insurance alongside options like HSA/FSA and disability coverage. Benefits are often seen as a meaningful part of the overall package.
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Retirement Support — A 401(k) with employer matching and an ESPP are offered, and the retirement plan is commonly regarded as a plus. These features help round out compensation even when base pay is seen as only acceptable.
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Leave & Time Off Breadth — PTO, paid holidays, and paid parental leave are part of the offering, with time‑off benefits generally viewed favorably. Backup family care and an employee assistance program add practical support.
Molina Healthcare Inc. Insights
What We Do
Molina Healthcare Inc. is dedicated to delivering effective, reliable, and affordable health care to those who need it most. The company focuses on improving the health and well-being of its members and positively impacting the communities it serves. Recognized as a leader in the health insurance category, it provides essential healthcare services to ensure accessible and quality care for its members.
