Job Information
Molina Healthcare Examiner, Claims in Washington
JOB DESCRIPTION
Job Summary:
The Claims Research Coordinator is responsible for reviewing claims to understand the root cause of issues and collaborating with various teams to identify and implement fixes. This role requires a keen eye for detail, strong analytical skills, and the ability to work effectively with cross-functional teams. The coordinator will also be responsible for meeting quality and production goals.
Key Responsibilities:
· Review and analyze claims to identify root causes of issues.
· Collaborate with various teams, including IT, configuration, provider data management, customer service, health plan operations and additional shared services teams, to resolve claim issues and implement fixes.
· Meet quality and production goals.
· Maintain detailed records of claim reviews and resolutions.
· Provide feedback and recommendations for process improvements.
· Participate in training and development activities to stay current with industry standards and best practices.
Qualifications:
· Bachelor's degree in a related field or equivalent work experience.
· Minimum of 3 years of experience in claims processing or a related field.
· Strong analytical and problem-solving skills.
· Excellent communication and collaboration skills.
· Ability to work independently and as part of a team.
· Experience with Excel
Preferred Qualifications :
· Experience with root cause analysis and process improvement methodologies.
· Knowledge of industry regulations and compliance standards.
· Familiarity with Salesforce and iServe for managing claims inquiries and adjustment requests
· Understanding of billing and coding procedures, including CPT and ICD codes.
· Experience with Medicaid, Medicare, and Marketplace claims.
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: $20.29 - $31.71 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina Healthcare
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