Examiner, Claims (Remote, Must Reside in Florida)

Molina Healthcare; Tampa (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company in Tampa is looking for a Claims Administrator to manage claims payments and maintain records. The ideal candidate will have 1-3 years of experience and an HS Diploma. Responsibilities include evaluating claims for errors and ensuring timely processing. This role offers a competitive hourly pay range of $13.55 - $26.42.

Benefits

Competitive benefits and compensation package

Qualifications

• 1-3 years of experience in claims management required.
• 3-5 years of experience preferred.

Responsibilities

• Administer claims payments and maintain claim records.
• Monitor workflow of claims and ensure timely settlements.
• Evaluate claims for incorrect coding and potential fraud.

Skills

Claims adjudication

Knowledge of state specific policies

Analytical skills

Attention to detail

Education

HS Diploma or GED

Associate degree or equivalent

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.

KNOWLEDGE/SKILLS/ABILITIES

• 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.

JOB 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.