**JOB DESCRIPTION** **Job Summary** 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. **KNOWLEDGE/SKILLS/ABILITIES** + 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 **Required Experience** 3-5 years claims processing required **Preferred Education** Bachelor's Degree or equivalent combination of education and experience **Preferred Experience** 5-7 years claims processing preferred QNXT, Workflow and Salesforce 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. Pay Range: $14.9 - $29.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.