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.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 06/20/2025