Sr Examiner, Claims
Molina Healthcare, Inc
San Juan, Puerto Rico
hace 6 días

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
  • 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

    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.

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