Molina’s Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!

Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences

JOB DESCRIPTION

Job Summary

• Responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues.
• Actively researching issues to adjudicate claims.
• Requires knowledge of operational areas and systems.

Job Duties

• Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.
• Involved in member enrollment, provider information management, benefits configuration and/or claims processing.
• Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.
• Assists in the reviews of state or federal complaints related to claims.
• Supports the other team members with several internal departments to determine appropriate resolution of issues.
• Researches tracers, adjustments, and re-submissions of claims.
• Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.
• Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.
• Handles special projects as assigned.

Job Function

• Provides customer support and stellar service to assist Molina providers with claims inquiries.
• Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions.
• Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries.
• Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers.
• Helps to mentor and coach Provider Claims Adjudicators

Required Experience

• Associate's Degree
• 2-3 years of customer service, claims, provider and investigation/research experience. Outcomes focused and knowledge of multiple systems.
• 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
• Or any combination of education and experience.

Preferred Experience

• Bachelor's Degree
• 2-3 years of customer service, claims, provider and investigation/research experience. Outcomes focused and knowledge of multiple systems.
• 4 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
• Or any combination of education and experience.

PHY S I C AL DEM A N D S :
W o rki n g en v i r o nm ent is g e n erally f a vo r a b le and li gh t i n g and t e m p erature are a d eq u at e . W o rk is g eneral l y p erf o r m ed in an o ff i ce or home office e n v i r o n m ent in w h i c h t h ere is o n l y m i n i m al e x p o su r e to u np leasa n t a nd /o r ha z ar d o u s w o rki n g c o nd iti o n s. M u s t h a v e t h e a b ility t o s i t f o r l o n g p eri o d s. Rea s o n a b le acc om mo d a ti o n s m a y be m a d e to e n a b le in d i v i du als with d i sa b ilities t o p er f o r m t h e e ssential fu n cti o n .

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: $25,621.75 - $49,962.41 a year*

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Please Note :
epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.