Adjudicator, Provider Claims-On the phone

divh2Job Summary/h2pProvides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims./ph3Essential Job Duties/h3ulliProvides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution./liliCollaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues./liliResponds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions./liliAssists in reviews of state and federal complaints related to claims./liliCollaborates with other internal departments to determine appropriate resolution of claims issues./liliResearches claims tracers, adjustments, and resubmissions of claims./liliAdjudicates or readjudicates high volumes of claims in a timely manner./liliManages defect reduction by identifying and communicating claims error issues and potential solutions to leadership./liliMeets claims department quality and production standards./liliSupports claims department initiatives to improve overall claims function efficiency./liliCompletes basic claims projects as assigned./li/ulh3Required Qualifications/h3pAt least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. Research and data 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 experience. Effective verbal and written communication skills. Microsoft Office suite and applicable software programs proficiency./ppMolina 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./p/div