JOB DESCRIPTION Job Summary
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
Required Qualifications • At least 2 years of experience in claims, 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.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
Health care claims/billing experience.
Medicaid 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
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.
