Work in Washington Veterans Jobs

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.