Examiner, Claims (Remote)
Molina Healthcare•Long Beach, CA
•Remote
About The Position
The Examiner, Claims provides support for claims examination activities. The role evaluates claims adjudication to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors, while helping improve claims quality and efficiency.
Requirements
- At least 1 year of experience in a clerical role in claims and/or customer service, preferably in managed care, or an equivalent combination of relevant education and experience.
- Data entry and research skills.
- Organizational skills and attention to detail.
- Time-management skills and the ability to manage simultaneous projects and tasks to meet internal deadlines.
- Customer service experience.
- Effective verbal and written communication skills.
- Proficiency in the Microsoft Office suite and applicable software programs.
Nice To Haves
- Health care claims/billing experience.
Responsibilities
- Evaluate claims adjudication using standard principles and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.
- Manage a caseload of claims and obtain medical records and statements that support each claim.
- Recommend further investigation and/or resolution of claims.
- Proactively identify error issues related to pre-payment claims adjudication and trend identification, and recommend solutions to resolve them.
- Meet claims department quality and production standards.
- Support claims department initiatives to improve overall claims function efficiency.
- Complete basic claims projects as assigned.
Benefits
- Competitive benefits and compensation package.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
