Lead Adjudicator, Provider Claims( Remote)-closing shift

Molina Healthcare•United States,

9d•$18 - $39•Remote

About The Position

Provides lead level support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.

Requirements

Associate’s Degree or equivalent combination of education and experience
Minimum 3 years as a Provider Claims Adjudicator
Previous claims adjusting experience
Customer services skills
Problem solving skills
Critical thinking skills
Research and resolution skills
Strong attention to detail
Strong analytical skills

Nice To Haves

Bachelor’s Degree or equivalent combination of education and experience
6+ years previous claims adjusting and customer services experience

Responsibilities

Coordinates workflow and staffing of day-to-day claims adjudication activities, and assigns and monitors work of staff to ensure adherence to productivity and quality standards.
Manages escalations within the claims department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
Performs daily claims troubleshooting procedures to support provider claims function as needed.
Participates in or leads quality improvement efforts to improve claims processes and/or policies.
Serves as provider claims subject matter expert; provides feedback to team and facilitates training as needed.
Reviews claims deficiencies and makes recommendations to increase efficiencies and provider satisfaction.
Sets standard with team for exemplary customer service delivery and ensures the team is meeting established claims metrics and compliance measures.
Partners with stakeholders and leaders in other functions to coordinate provider claims-related problem-solving in an effective and timely manner.
Provides technical claims expertise to peers and handles complex provider calls.
Assists with training needs of claims department staff.
Assists leadership with claims staff development.
Recognizes trends and patterns in call and claims types and engages leadership with suggested solutions.
Meets department quality and production standards.
Supports all claims department initiatives to improve overall efficiency.
Completes claims projects as assigned.