Examiner, Claims - Molina Healthcare : Job Details

**JOB DESCRIPTION****Job Summary:**The Claims Research Coordinator is responsible for reviewing claims to understand the root cause of issues and collaborating with various teams to identify and implement fixes. This role requires a keen eye for detail, strong analytical skills, and the abilityto work effectively with cross-functional teams. The coordinator will also be responsible for meeting quality and production goals.**Key Responsibilities:**· Review and analyze claims to identify root causes of issues.· Collaborate with various teams, including IT, configuration, provider data management, customer service, health plan operations and additional shared services teams, to resolve claim issues and implement fixes.· Meet quality and production goals.· Maintain detailed records of claim reviews and resolutions.· Provide feedback and recommendations for process improvements.· Participate in training and development activities to stay current with industry standards and best practices.**Qualifications:**· Bachelor's degree in a related field or equivalent work experience.· Minimum of 3 years of experience in claims processing or a related field.· Strong analytical and problem-solving skills.· Excellent communication and collaboration skills.· Ability to work independently and as part of a team.· Experience with Excel**Preferred Qualifications** :· Experience with root cause analysis and process improvement methodologies.· Knowledge of industry regulations and compliance standards.· Familiarity with Salesforce and iServe for managing claims inquiries and adjustment requests· Understanding of billing and coding procedures, including CPT and ICD codes.· Experience with Medicaid, Medicare, and Marketplace claims.To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Pay Range: $20.29 - $31.71 / HOURLY*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.