Examiner, Claims (Remote, Must Reside in Florida)

Molina Healthcare; Miami (FL); Remote; USD 80,000 - 100,000; Full time

Job summary

A healthcare company in Miami is seeking a Claims Processor responsible for administering claims payments and maintaining records. The role involves evaluating claims, managing caseloads, and ensuring compliance with regulations. Candidates must have a HS Diploma or GED with 1-3 years of experience. This position offers a competitive pay range of $13.55 - $26.42 per hour.

Benefits

Competitive benefits package

Qualifications

• 1-3 years of experience in claims processing.
• Strong understanding of claims adjudication principles.
• Experience with state-specific policies and regulations.

Responsibilities

• Evaluate the adjudication of claims to identify errors.
• Manage caseload and procure necessary medical records.
• Support department initiatives to improve efficiency.

Skills

Claims evaluation

Attention to detail

Error identification

Efficiency improvement

Education

HS Diploma or GED

Associate degree

Job description

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.

Overview

Responsibilities summarized above; detailed responsibilities and qualifications follow.

Responsibilities

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.
• Manages a caseload of claims. Procures all medical records and statements that support the claim.
• Makes recommendations for further investigation or resolution.
• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.
• Supports all department initiatives in improving overall efficiency.
• Meets department quality and production standards.
• Other duties as assigned.

Qualifications

• Required Education: HS Diploma or GED
• Required Experience: 1-3 years
• Preferred Education: Associate degree or equivalent combination of education and experience
• Preferred Experience: 3-5 years

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: $13.55 - $26.42 / HOURLY

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