Molina Healthcare · 1 month ago
Claims Auditor
New York, United States
Full-time
Onsite
Entry Level
$18.35/hr - $42.20/hr
2+ years expMolina Healthcare is a prominent healthcare provider, and they are seeking a Claims Auditor to support their claims audit activities. The role involves identifying incorrect coding and fraudulent billing practices, preparing audit findings reports, and ensuring compliance with claims processing requirements.
Health CareHospitalMedical
Responsibilities
Audits the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing of claims errors
Prepares, tracks and provides claims audit findings reports according to established timelines
Presents claims audit findings and makes recommendations to leadership for improvements based on audit results
Reviews timeliness of claims processing to ensure compliance with contractual and state/federal requirements
Maintains minimum claims audit accuracy rate per contractual guidelines
Supports claims department initiatives to improve overall claims function efficiency
Meets claims audit department quality and production standards
Completes basic claims projects as assigned
Experience in reviewing high $ claims, claims payment method
Qualification
Required
At least 2 years of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience
Audit, research, and data entry 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
Preferred
Health care claims auditing/billing experience
Benefits
Competitive benefits and compensation package
Company
Molina Healthcare
Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.
10001+ employees
H1B Sponsorship
Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (56)
2024 (45)
2023 (43)
2022 (31)
2021 (35)
2020 (55)
Funding
Current Stage
Public CompanyTotal Funding
$2.35B2025-11-17Post Ipo Debt· $850M
2024-11-13Post Ipo Debt· $750M
2021-11-16Post Ipo Debt· $750M
Leadership Team
Dave Reynolds
Executive Vice President, Health Plans & Medicaid Chief Operating Officer
Debbie Simkins
Vice President, Office of the CIO
Recent News
2026-01-17
Company data provided by crunchbase