Molina Healthcare · 1 week ago
Adjudicator, Provider Claims-On the phone
United States
Full-time
Remote
Entry Level
$21.16/hr - $38.37/hr
2+ years expMolina Healthcare is a provider of managed care services, and they are seeking an Adjudicator for Provider Claims. The role involves supporting provider claims adjudication activities, resolving claim issues, and collaborating with various teams to ensure appropriate resolution of claims.
Health CareHospitalMedical
Responsibilities
Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution
Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues
Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions
Assists in reviews of state and federal complaints related to claims
Collaborates with other internal departments to determine appropriate resolution of claims issues
Researches claims tracers, adjustments, and resubmissions of claims
Adjudicates or readjudicates high volumes of claims in a timely manner
Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership
Meets claims department quality and production standards
Supports claims department initiatives to improve overall claims function efficiency
Completes basic claims projects as assigned
Qualification
Required
At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience
Research and data analysis 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
Benefits
Molina Healthcare offers a 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
2026-01-03
Company data provided by crunchbase