JOB DESCRIPTION Job Summary
Provides entry level analyst support for claims research activities. Ensures
timely and accurate resolution of provider submitted claims issues/inquiries.
Leverages understanding of medical claims processing and uses analytical skills
to effectively triage issues to facilitate claims investigation or correction.
Meets established production and quality standard. Identifies trends in claims
issues to inform process improvements and drive continuous improvement in claims
performance and compliance.
Essential Job Duties
• Reviews and analyzes claims-related issues submitted by providers to identify
potential root-cause issues; triages issues quickly and accurately.
• Triages issues based on type and complexity, assigning 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 claims 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 related to
provider claims research.
Required Qualifications
• At least 1 year of experience in medical claims processing/research and/or
health care operations , or equivalent combination of relevant education and
experience.
• Basic medical claims processing knowledge.
• Data research and analysis skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks
to meet internal deadlines.
• Customer service skills.
• Problem-solving skills.
• Ability to work independently and as part of a team, and collaborate
cross-functionally across a highly matrixed organization.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs
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