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Molina Healthcare: Senior claims examiner

Molina Healthcare

This is a Full-time position in Troy, MI posted June 10, 2020.

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
• Meets and consistently maintains production standards for Claims Adjudication.

• Supports all department initiatives in improving overall efficiency.

• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.

• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues.

• Monitors the medical treatment of claimants.

Keeps meticulous notes and records for each claim.

• Manages a caseload of various types of complex claims.

Procures all medical records and statements that support the claim.

• Meets department quality and production standards.

• Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business Qualifications Job Qualifications Required Education High School or GED Required Experience 3-5 years claims processing required Preferred Education Bachelor’s Degree or equivalent combination of education and experience Preferred Experience 5-7 years claims processing preferred