Claims Adjuster
Provides support for claims adjustment activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Also monitors and controls backlog and workflow of claims, and ensures that claims are settled in a timely fashion and in accordance with cost-control standards.
Researches claims tracers, adjustments and resubmissions.
Assists with defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
Adjudicates or readjudicates claims in a timely manner.
Meets claims department quality and production standards.
Supports claims department initiatives to improve overall claims function efficiency.
Completes basic claims projects as assigned.
At least 1 year 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.
Data entry and research 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.
Health care claims/billing experience.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Adjuster, Claims • Long Beach, CA, US
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