Auto claims adjuster Jobs in Savannah, GA

Job Description

Job Summary

Join our team as a Senior Claims Research Analyst, where you will play a pivotal role in the realm of claims processing and research. As a senior-level subject matter expert, you will lead complex and high-priority claims initiatives. This role combines advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across various departments to tackle persistent claims processing challenges. You will provide thought leadership, devise effective remediation strategies, and ensure the execution of projects is timely and precise, all while driving continuous improvement in claims performance and compliance. You will also represent our organization in internal and external meetings, effectively communicating findings and resolution plans.

Key Responsibilities

Utilize advanced analytical skills to conduct thorough research and analysis for critical claims projects.

Reduce re-work by identifying and addressing claims processing issues effectively.

Interpret regulatory and contractual requirements to ensure compliance.

Customize existing reports and leverage data to fulfill claims project needs.

Evaluate claims in accordance with standard principles and state-specific regulations to pinpoint processing errors.

Serve as a senior subject matter expert for complex claims, ensuring adherence to compliance standards.

Lead and manage intricate claims research projects sparked by provider inquiries or internal audits.

Perform advanced root cause analysis to identify systemic processing errors and collaborate with departments to implement sustainable solutions.

Ensure compliance with regulatory and contractual mandates in claims adjudication and remediation efforts.

Develop, track, and supervise remediation plans to guarantee timely and accurate claims reprocessing.

Deliver in-depth analyses and insights to leadership and operational teams, presenting findings and progress in a clear, actionable manner.

Lead provider meetings when necessary, clearly outlining findings, proposed solutions, and updates while fostering a professional and collaborative environment.

Proactively recommend updates to policies, SOPs, and job aids to enhance claims quality and efficiency.

Collaborate with external departments and leadership to precisely define claims requirements, aligning with organizational objectives.

Qualifications

Required Qualifications :

5+ years of experience in medical claims processing or research.

Expertise in regulatory and contractual claims requirements, root cause analysis, and project management.

Advanced knowledge of medical billing codes and claims adjudication processes.

Strong analytical, organizational, and problem-solving abilities.

Proficiency in claims management systems and data analysis tools.

Exceptional communication skills with the ability to convey complex information to diverse audiences, including executive leadership and providers.

Proven capability to manage multiple projects, prioritize effectively, and meet deadlines in a fast-paced environment.

Proficient in Microsoft Office Suite and relevant software programs.

Preferred Qualifications :

Bachelor's Degree or equivalent combination of education and experience.

Project management experience.

Advanced skills in Excel and PowerPoint.

Familiarity with systems for managing claims inquiries and adjustment requests.

If you are excited about bringing your skills to our dedicated team, please apply through our Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package and is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $80,168 - $106,214 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education, and / or skill level.