JOB DESCRIPTION Job Summary
Provides lead level support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.
Essential Job Duties
Job Qualifications
REQUIRED EDUCATION:
Associate’s Degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
Minimum 3 years as a Provider Claims Adjudicator
Previous claims adjusting experience as well and customer services, problem solving, critical thinking skills and research and resolution skills.
Strong attention to detail
Strong analytical skills
PREFERRED EDUCATION:
Bachelor’s Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
6+ years previous claims adjusting and customer services experience
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an 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.
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
Molina Healthcare is a managed care organization that provides health insurance and care management services, primarily serving Medicaid members. The company operates health plans and delivers integrated care coordination across the continuum of care, combining medical management with behavioral health, long-term services and supports (LTSS), and community resources. Molina employs advanced claims processing systems, risk adjustment methodologies, and quality performance management to ensure cost-effective, high-quality member outcomes. The company supports various health plans and regulatory requirements while managing complex operations including provider contracting, benefits configuration, and HEDIS audit compliance.
