Molina Healthcare Hiring for CLAIMS REP, CUSTOMER EXPERIENCE Virtual Hiring Event Job at Lexington, KY Full Time

JOB DESCRIPTION

Job Summary

• Responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues.
• Actively researching issues to adjudicate claims.
• Requires knowledge of operational areas and systems.

Job Duties

• Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.
• Involved in member enrollment, provider information management, benefits configuration and/or claims processing.
• Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.
• Assists in the reviews of state or federal complaints related to claims.
• Supports the other team members with several internal departments to determine appropriate resolution of issues.
• Researches tracers, adjustments, and re-submissions of claims.
• Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.
• Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.
• Handles special projects as assigned.

Job Function

• Provides customer support and stellar service to assist Molina providers with claims inquiries.
• Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions.
• Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries.
• Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers.
• Helps to mentor and coach Provider Claims Adjudicators

Required Experience

• Associate’s Degree
• 2-3 years of customer service, claims, provider and investigation/research experience. Outcomes focused and knowledge of multiple systems.
• 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
• Or any combination of education and experience.

Preferred Experience

• Bachelor’s Degree
• 2-3 years of customer service, claims, provider and investigation/research experience. Outcomes focused and knowledge of multiple systems.
• 4 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
• Or any combination of education and experience.

Preferred dress code

Business (business suit, tie)

What is a virtual interview?

Virtual interviews help employers connect with job seekers when they are not in the same physical location. Since hiring is a human process, employers would like to talk with you online (chat, video or phone) to see if you meet the requirements for the job.