Job Details

Job Description

Job Summary

Provides entry level analyst support for claims research activities. This role plays a pivotal role in ensuring the timely and accurate resolution of provider-submitted claims issues. This role requires a keen understanding of medical claims processing, strong analytical skills, and the ability to effectively triage issues to the appropriate department for further investigation or correction. This is a production-based role, with clear expectations for meeting production and quality standards.

Job Duties

• Reviews and analyzes claims-related issues submitted by providers to identify potential root causes quickly and accurately.

• Triages issues based on type and complexity, assigning them to the appropriate department or team for further research or correction.

• Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate assessments.

• Meets quality and production goals.

• Maintains detailed records of claim reviews and resolutions.

• Identifies trends in submitted issues to inform process improvements and reduce recurring errors.

• Provides feedback and recommendations for process improvements.

• Completes training and development activities to stay current with industry standards and best practices.

Job Qualifications

REQUIRED QUALIFICATIONS:

• At least 1 year of experience in claims processing or operations or equivalent combination of relevant education and experience

• Basic knowledge of medical billing and basic claims processes.

• Problem-solving skills

• Verbal and written communication skills and ability to collaborate

• Ability to work independently and as part of a team

• Microsoft Office suite/applicable software program(s) proficiency

PREFERRED QUALIFICATIONS:

• Experience with process improvement methodologies.

• Knowledge of industry regulations and compliance standards.

• Familiarity with systems used to manage claims inquiries and adjustment requests

• Understanding of billing and coding procedures

• 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 Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.16 - $38.37 / HOURLY

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