Molina Healthcare of Florida is hiring for several Sr. Claims Examiners.
These roles remote, however candidates must reside in Florida.
Ideal candidates will have experience with claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience a plus!
KNOWLEDGE/SKILLS/ABILITIES
- 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.
- Other duties as assigned.
JOB QUALIFICATIONS
Required Education: High School or GED
Preferred Education: Bachelor's Degree or equivalent combination of education and experience
Required Experience: 3-5 years claims processing required
Preferred 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.
Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance, Front End Claims, Claims Processing, Excel
United States
