Job Description

Job Description

Molina Healthcare of Florida is hiring for several Claims Examiners.
These positions are remote; however, all candidates must reside in the state of Florida .

Those with Health Insurance call center experience are encouraged to apply. This is an entry level position where you have the opportunity for growth & advancement.

As a Claims Examiner, you will be responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensure that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.
• Manages a caseload of claims. Procures all medical records and statements that support the claim.
• Makes recommendations for further investigation or resolution.
• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.
• Supports all department initiatives in improving overall efficiency.
• Meets department quality and production standards.
• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : HS Diploma or GED
Preferred Education : Associate degree or equivalent combination of education and experience

Required Experience : 1-3 years of claims knowledge
Preferred Experience : 3-5 years of claims knowledge

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

Job Tags

Remote job,

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