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Sr Claims Examiner Remote - Must Live In Florida
Molina Healthcare • Remote • Posted 2 days ago
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Remote • Full-time • $13.41-$29.06/hr • Senior Level
Job Highlights
Using AI ⚡ to summarize the original job post
Molina Healthcare of Florida is seeking Senior Claims Examiners for remote positions, requiring candidates to reside in Florida. The role involves administering claims payments, maintaining claim records, and ensuring timely and accurate settlement of claims in line with cost control standards. Ideal candidates will have experience in claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience is a plus.
Responsibilities
- Administering claims payments
- Maintaining claim records
- Monitoring and controlling backlog and workflow of claims
- Ensuring claims are settled in a timely fashion and in accordance with cost control standards
- Meeting and consistently maintaining production standards for Claims Adjudication
- Supporting all department initiatives in improving overall efficiency
- Identifying and recommending solutions for error issues as it relates to pre-payment of claims
- Overseeing 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
- Monitoring the medical treatment of claimants and keeping meticulous notes and records for each claim
- Managing a caseload of various types of complex claims
- Procures all medical records and statements that support the claim
- Meeting department quality and production standards
- Meeting State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business
Qualifications
Required
- High School diploma or GED
- 3-5 years of claims processing experience
Preferred
- Bachelor's Degree or equivalent combination of education and experience
- 5-7 years of claims processing experience
- QNXT experience
About Molina Healthcare
Molina Healthcare is a Fortune 500 managed care company operating in the United States. They offer Medicaid, Medicare, and Marketplace health plans, focusing on providing affordable, quality healthcare to underserved populations. The company has expanded through acquisitions, such as acquiring Magellan Complete Care to enter the Florida market and enhance their services.
Full Job Description
**Molina Healthcare of Florida** is hiring for several Sr. Claims Examiners.
These roles remote, however **candidates must reside in Florida.**
Ideal candidates will have experience with claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience a plus!
**KNOWLEDGE/SKILLS/ABILITIES**
+ 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.
+ 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.
+ Other duties as assigned.
**JOB QUALIFICATIONS**
**Required Education** : High School or GED
**Preferred Education** : Bachelor's Degree or equivalent combination of education and experience
**Required Experience** : 3-5 years claims processing required
**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.
Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance, Front End Claims, Claims Processing, Excel
Pay Range: $13.41 - $29.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
These roles remote, however **candidates must reside in Florida.**
Ideal candidates will have experience with claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience a plus!
**KNOWLEDGE/SKILLS/ABILITIES**
+ 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.
+ 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.
+ Other duties as assigned.
**JOB QUALIFICATIONS**
**Required Education** : High School or GED
**Preferred Education** : Bachelor's Degree or equivalent combination of education and experience
**Required Experience** : 3-5 years claims processing required
**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.
Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance, Front End Claims, Claims Processing, Excel
Pay Range: $13.41 - $29.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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