Adjudicator, Provider Claims - Remote Ohio On the phone-closing shift

JOB DESCRIPTION Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. Hours - M-F 12pm -8:30pm EST Essential Job Duties Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents reputed company calls and interactions. Strong claims adjusting experience as well and customer services, problem solving, critical thinking skills and research and resolution skills.

• Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution.
• Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues.
• Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents reputed company calls and interactions.
• Assists in reviews of state and federal complaints reputed company to claims.
• Collaborates with other internal departments to determine appropriate resolution of claims issues.
• Researches claims tracers, adjustments, and resubmissions of claims.
• Adjudicates or readjudicates high volumes of claims in a timely manner.
• Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
• Meets claims department quality and production standards.
• Supports claims department initiatives to improve overall claims function efficiency.
• Completes basic claims projects as assigned.

Required Qualifications

• At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis reputed company a managed care organization, or equivalent combination of relevant education and experience.
• Research and data analysis 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.
• reputed company Office suite and applicable software programs proficiency.

Knowledgeable In Systems Utilized reputed company QNXT Pega Claim Shark reputed company To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job