Company Detail

Job Description

Molina Healthcare of Florida is hiring for several Claims Examiners.

These positions are remote; however, all candidates must reside in the state of Florida .

Those with Health Insurance call center experience are encouraged to apply. This is an entry level position where you have the opportunity for growth & advancement.

As a Claims Examiner, you will be responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensure that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.

• Manages a caseload of claims. Procures all medical records and statements that support the claim.

• Makes recommendations for further investigation or resolution.

• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.

• Supports all department initiatives in improving overall efficiency.

• Meets department quality and production standards.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : HS Diploma or GED

Preferred Education : Associate degree or equivalent combination of education and experience

Required Experience : 1-3 years of claims knowledge

Preferred Experience : 3-5 years of claims knowledge

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance

Pay Range: $12.19 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, community, and nursing facility settings. Provides needed care in the environment that patients feel most comfortable and are most receptive including home, nursing facilities, and -pop up- clinic.

The Nurse Practitioner will be required to work primarily in non-clinical settings and provide medical care to all levels of patients. Some programs may focus on specific populations (e.g., adult and geriatric, pediatric, women's health).

Perform comprehensive medical assessments, order appropriate tests/procedures for diagnostic purposes, formulate treatment plans, obtain specialists' consultations as needed, and do appropriate documentations as required.

Job Duties

• Provide general medical care and care coordination to various and/or specific patient levels - adults, women's health, pediatric, and geriatric.

• Perform comprehensive evaluations including history and physical exams for gaps in care and preventative assessments

• Address both chronic and acute primary care complaints, and able to ascertain medical urgency

• Establish and document reasonable medical diagnoses

• Seek specialty consultation as appropriate

• Order/perform pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptom; able to work within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately

• Responsible for knowing when a patient's needs are beyond their scope of knowledge and when physician oversight is needed.

• Create and implements a medical plan of care

• Schedule patient appointments for visits when appropriate

• Provide post discharge coordination to reduce hospital readmission rates and emergency room utilization

• Perform face-to-face in-person visits in a variety of settings including home, skilled nursing facilities, and public locations.

• Additionally, may perform face-to-face visits via alternate modalities based on business need, leadership direction, and state regulations

• Order bulk laboratory orders to target specific populations of member.

• Perform alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develop appropriate plan of care

• Participate in community-based -Pop Up Clinics- as way of building relationship with community while addressing gaps in health care

• Drive up to 120 miles a day on a regular basis to a variety of locations within the assigned region. There may be drives beyond 120 miles as part of Extended Mileage Special Project days. Special Projects may include an overnight hotel stay.

• Obtain and maintain cross state license in other states besides home state based on business need.

• Collaborate with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively

• Actively participate in regional meetings

• Prescribe medications and perform procedures as appropriate

• Perform timely documentation in medical records in an electronic medical record computer system

• On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Master's degree in family health from accredited nursing program

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

Advanced computer skills. Proficient with Word, Excel, and Electronic Medical Record.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

• An active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners; American Nurses Credentialing Center

• Current state-issued license to practice as a Family Nurse Practitioner

• Current Basic Life Support for Healthcare Professional certification

• Current unrestricted driver's license

PREFERRED EDUCATION:

PREFERRED EXPERIENCE:

• 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a home health, community health, or public health setting

• Previous experience in home health as a licensed clinician, especially in management of chronic conditions

• Experience with underserved populations facing socioeconomic barriers to health care

• Fluency in a language in addition to English is plus

• Immunization and point of care testing skills

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: $46,237 - $90,161 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Claims Examiners.

These positions are remote; however, all candidates must reside in the state of Florida .

Those with Health Insurance call center experience are encouraged to apply. This is an entry level position where you have the opportunity for growth & advancement.

As a Claims Examiner, you will be responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensure that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.

• Manages a caseload of claims. Procures all medical records and statements that support the claim.

• Makes recommendations for further investigation or resolution.

• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.

• Supports all department initiatives in improving overall efficiency.

• Meets department quality and production standards.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : HS Diploma or GED

Preferred Education : Associate degree or equivalent combination of education and experience

Required Experience : 1-3 years of claims knowledge

Preferred Experience : 3-5 years of claims knowledge

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance

Pay Range: $12.19 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

*This position is remote and employee must reside in Florida*

Job Summary

Analyzes complex business problems and claims issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Provides analytical, problem solving foundation within claims including: definition and documentation, specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• 1-3 years formal training in Business Analysis and/or Systems Analysis

• 1+ years claims background

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: $19.64 - $42.55 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Sr. Claims Examiners.

These roles remote, however candidates must reside in Florida.

Ideal candidates will have experience with claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience a plus!

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.

• Meets and consistently maintains production standards for Claims Adjudication.

• Supports all department initiatives in improving overall efficiency.

• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.

• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues.

• Monitors the medical treatment of claimants. Keeps meticulous notes and records for each claim.

• Manages a caseload of various types of complex claims. Procures all medical records and statements that support the claim.

• Meets department quality and production standards.

• Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : High School or GED

Preferred Education : Bachelor's Degree or equivalent combination of education and experience

Required Experience : 3-5 years claims processing required

Preferred Experience : 5-7 years claims processing preferred

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance, Front End Claims, Claims Processing, Excel

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

*This position is remote and employee must reside in Florida*

Job Summary

Analyzes complex business problems and claims issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Provides analytical, problem solving foundation within claims including: definition and documentation, specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• 1-3 years formal training in Business Analysis and/or Systems Analysis

• 1+ years claims background

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: $19.64 - $42.55 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Sr. Claims Examiners.

These roles remote, however candidates must reside in Florida.

Ideal candidates will have experience with claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience a plus!

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.

• Meets and consistently maintains production standards for Claims Adjudication.

• Supports all department initiatives in improving overall efficiency.

• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.

• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues.

• Monitors the medical treatment of claimants. Keeps meticulous notes and records for each claim.

• Manages a caseload of various types of complex claims. Procures all medical records and statements that support the claim.

• Meets department quality and production standards.

• Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : High School or GED

Preferred Education : Bachelor's Degree or equivalent combination of education and experience

Required Experience : 3-5 years claims processing required

Preferred Experience : 5-7 years claims processing preferred

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance, Front End Claims, Claims Processing, Excel

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Claims Examiners.

These positions are remote; however, all candidates must reside in the state of Florida .

Those with Health Insurance call center experience are encouraged to apply. This is an entry level position where you have the opportunity for growth & advancement.

As a Claims Examiner, you will be responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensure that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.

• Manages a caseload of claims. Procures all medical records and statements that support the claim.

• Makes recommendations for further investigation or resolution.

• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.

• Supports all department initiatives in improving overall efficiency.

• Meets department quality and production standards.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : HS Diploma or GED

Preferred Education : Associate degree or equivalent combination of education and experience

Required Experience : 1-3 years of claims knowledge

Preferred Experience : 3-5 years of claims knowledge

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance

Pay Range: $12.19 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Claims Examiners.

These positions are remote; however, all candidates must reside in the state of Florida .

Those with Health Insurance call center experience are encouraged to apply. This is an entry level position where you have the opportunity for growth & advancement.

As a Claims Examiner, you will be responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensure that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.

• Manages a caseload of claims. Procures all medical records and statements that support the claim.

• Makes recommendations for further investigation or resolution.

• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.

• Supports all department initiatives in improving overall efficiency.

• Meets department quality and production standards.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : HS Diploma or GED

Preferred Education : Associate degree or equivalent combination of education and experience

Required Experience : 1-3 years of claims knowledge

Preferred Experience : 3-5 years of claims knowledge

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance

Pay Range: $12.19 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

*This position is remote and employee must reside in Florida*

Job Summary

Analyzes complex business problems and claims issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Provides analytical, problem solving foundation within claims including: definition and documentation, specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• 1-3 years formal training in Business Analysis and/or Systems Analysis

• 1+ years claims background

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: $19.64 - $42.55 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Sr. Claims Examiners.

These roles remote, however candidates must reside in Florida.

Ideal candidates will have experience with claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience a plus!

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.

• Meets and consistently maintains production standards for Claims Adjudication.

• Supports all department initiatives in improving overall efficiency.

• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.

• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues.

• Monitors the medical treatment of claimants. Keeps meticulous notes and records for each claim.

• Manages a caseload of various types of complex claims. Procures all medical records and statements that support the claim.

• Meets department quality and production standards.

• Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : High School or GED

Preferred Education : Bachelor's Degree or equivalent combination of education and experience

Required Experience : 3-5 years claims processing required

Preferred Experience : 5-7 years claims processing preferred

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance, Front End Claims, Claims Processing, Excel

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

*This position is remote and employee must reside in Florida*

Job Summary

Analyzes complex business problems and claims issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Provides analytical, problem solving foundation within claims including: definition and documentation, specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• 1-3 years formal training in Business Analysis and/or Systems Analysis

• 1+ years claims background

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: $19.64 - $42.55 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Claims Examiners.

These positions are remote; however, all candidates must reside in the state of Florida .

Those with Health Insurance call center experience are encouraged to apply. This is an entry level position where you have the opportunity for growth & advancement.

As a Claims Examiner, you will be responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensure that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.

• Manages a caseload of claims. Procures all medical records and statements that support the claim.

• Makes recommendations for further investigation or resolution.

• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.

• Supports all department initiatives in improving overall efficiency.

• Meets department quality and production standards.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : HS Diploma or GED

Preferred Education : Associate degree or equivalent combination of education and experience

Required Experience : 1-3 years of claims knowledge

Preferred Experience : 3-5 years of claims knowledge

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance

Pay Range: $12.19 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Sr. Claims Examiners.

These roles remote, however candidates must reside in Florida.

Ideal candidates will have experience with claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience a plus!

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.

• Meets and consistently maintains production standards for Claims Adjudication.

• Supports all department initiatives in improving overall efficiency.

• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.

• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues.

• Monitors the medical treatment of claimants. Keeps meticulous notes and records for each claim.

• Manages a caseload of various types of complex claims. Procures all medical records and statements that support the claim.

• Meets department quality and production standards.

• Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : High School or GED

Preferred Education : Bachelor's Degree or equivalent combination of education and experience

Required Experience : 3-5 years claims processing required

Preferred Experience : 5-7 years claims processing preferred

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance, Front End Claims, Claims Processing, Excel

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Candidates For This Position Must Reside In/Near the Erie County Area

Are you passionate about serving others? Do you have established relationships within the community?

Come join our growing Community Engagement team at Molina Healthcare !

Community Outreach and Engagement is more than just participating in events- at Molina, we focus on making an impact on people's lives!

This role involves working with a wide variety of community partners to grow Molina's membership and improve the health and well-being of the Community. Our Specialists work collaboratively with our sales team and across Molina and with each other's regions. You would be responsible for managing events and community relationships in Erie and surrounding counties. You will be in the field engaging with CBO's (Community Based Organizations) 50% or more of the time (Molina reimburses mileage).

This position offers great flexibility and allows for you to manage your territory and schedule to meet business needs. Molina's leadership team leads with empowering you to do what you love best by helping others.

Bilingual (Spanish) Highly Desired!

*Candidates for this position must live in or near the Erie County Area*

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for achieving established goals improving Molina's enrollment growth objectives encompassing Medicaid programs. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages.

• Under limited supervision, responsible for carrying out enrollment events and achieving assigned membership growth targets through a combination of direct and indirect marketing activities, with the primary responsibility of improving the plan's overall -choice- rate. Works collaboratively with other key departments to increase the Medicaid assignment percentage for Molina.

• Works closely with other team members and management to develop/maintain/deepen relationships with key business leaders, community-based organizations (CBOs) and providers, ensuring all efforts are directed towards building membership for Medicaid and related programs. Effectively moves relationships through the -enrollment- pipeline.

• Responsible for achieving monthly, quarterly, and annual enrollment goals, and growth and choice targets, as established by management.

• Schedules, coordinates & participates in enrollment events, encourages key partners to participate, and assists where feasible.

• Works cohesively with Provider Services to ensure providers within assigned territory are aware of Molina products and services. Establishes simple referral processes for providers and CBOs to refer clients who may be eligible for other Molina products.

• Viewed as a -subject matter expert- (SME) by community and influencers on the health care delivery system and wellness topics.

• Delivers presentations, attends meetings and distributes educational materials to both members and potential members.

• Assists with all incoming calls and assist perspective members or members with health access related questions.

• Identify partnerships with key sponsorship opportunities and provide justification to determine Molina's participation.

• Identify and promote Molina's programs out in the community and creates opportunities for employees to participate.

• Responsible for managing their own daily schedule in alignment with department goals and initiatives as assigned by regions.

• Key in the development of SMART goals and provide input on department priorities.

JOB QUALIFICATIONS

Required Education: Bachelor's Degree or equivalent, job-related experience.

Preferred Education: Bachelor's Degree in Marketing or related discipline.

Required Experience:

• Min. 3 years of related experience (e.g., marketing, business development, community engagement, healthcare industry).

• Demonstrated exceptional networking and negotiations skills.

• Demonstrated strong public speaking and presentations skills.

• Demonstrated ability to work in a fast-paced, team-oriented environment with little supervision.

• Must be able to attend public events in outdoor venues in all weather conditions.

• Must be able to sit and stand for long periods.

• Must be able to drive up to 3 hours to attend events. Must be able to lift 30 pounds.

Required License, Certification, Association:

• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Experience:

• Solid understanding of Health Care Markets, primarily Medicaid.

• Previous healthcare marketing, enrollment and/or grassroots/community outreach experience a plus.

• 5 years of outreach experience serving low-income populations.

• 3 - 5 years project management experience, preferably in a health care or outreach setting.

• Experience presenting to influencer and low-income audiences.

• Experience in sales or marketing techniques.

• Fluency in a second language highly desirable.

Preferred License, Certification, Association:

• Active Life & Health Insurance

• Market Place Certified

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.

Key Words: health care, insurance, health insurance, Medicaid, Medicare, health coach, community health advisor, family advocate, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter and public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, Sales, Growth, New York, MCO, Managed Care, ACA, FQHC, Behavioral Health, CHW, Community Health Worker, Equity, DPBH, HMO, SDOH

Pay Range: $16.23 - $35.17 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

The Manager, Healthcare Services provides operational management and oversight of integrated Healthcare Services (HCS) teams responsible for providing Molina Healthcare members with the right care at the right place at the right time and assisting them to achieve optimal clinical, financial, and quality of life outcomes.

• Responsible for clinical teams (including operational teams, where integrated) performing one or more of the following activities: care review/utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case management, transition of care, health management and/or member assessment.

• Typically, through one or more direct report supervisors, facilitates integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina Clinical Model.

• Manages and evaluates team member performance; provides coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training; and has responsibility for the selection, orientation and mentoring of new staff.

• Performs and promotes interdepartmental/ multidisciplinary integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Services & Supports for Molina members. Oversees Interdisciplinary Care Team meetings.

• Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.

• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.

• Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.

• Ensures completion of staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines.

• Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.

JOB QUALIFICATIONS

Required Education

• Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.

• OR Bachelor's or master's degree in Nursing, Gerontology, Public Health, Social Work, or related field.

Required Experience

• 5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management.

• Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.

• Experience working within applicable state, federal, and third-party regulations.

Required License, Certification, Association

• If licensed, license must be active, unrestricted and in good standing.

• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Master's Degree preferred.

Preferred Experience

• 3+ years supervisory/management experience in a managed healthcare environment.

• Medicaid/Medicare Population experience with increasing responsibility.

• 3+ years of clinical nursing experience.

Preferred License, Certification, Association

Any of the following:

Certified Case Manager (CCM), Certified Professional in Healthcare Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.

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: $73,101.84 - $142,548.59 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions, and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members and identifies opportunities to maintain and increase member relationships. Recommends and implements programs to support member needs.

KNOWLEDGE/SKILLS/ABILITIES

• Performs member outreach calls in states supported by Molina Healthcare to enforce member retention

• Answers incoming calls regarding Medicaid members in PEND status and those having Re-determination renewal dates.

• Helps members complete necessary paperwork related to either Medicaid eligibility renewal process.

• Assists Medicaid Members in contacting their social worker regarding eligibility issues and follow-up with members to ensure follow through, if allowed by the member's respective state.

• Accurately and timely documents member retention contacts in appropriate database.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

1-3 years

Required License, Certification, Association

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Associate's Degree

Preferred Experience

3-5 years

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.

#PJHPO

#LI-AC1

Pay Range: $16.5 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions, and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members and identifies opportunities to maintain and increase member relationships. Recommends and implements programs to support member needs.

KNOWLEDGE/SKILLS/ABILITIES

• Performs member outreach calls in states supported by Molina Healthcare to enforce member retention

• Answers incoming calls regarding Medicaid members in PEND status and those having Re-determination renewal dates.

• Helps members complete necessary paperwork related to either Medicaid eligibility renewal process.

• Assists Medicaid Members in contacting their social worker regarding eligibility issues and follow-up with members to ensure follow through, if allowed by the member's respective state.

• Accurately and timely documents member retention contacts in appropriate database.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

1-3 years

Required License, Certification, Association

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Associate's Degree

Preferred Experience

3-5 years

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.

#PJHPO

#LI-AC1

Pay Range: $16.5 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

*This position is remote and employee must reside in Florida*

Job Summary

Analyzes complex business problems and claims issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Provides analytical, problem solving foundation within claims including: definition and documentation, specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• 1-3 years formal training in Business Analysis and/or Systems Analysis

• 1+ years claims background

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: $19.64 - $42.55 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions, and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members and identifies opportunities to maintain and increase member relationships. Recommends and implements programs to support member needs.

KNOWLEDGE/SKILLS/ABILITIES

• Performs member outreach calls in states supported by Molina Healthcare to enforce member retention

• Answers incoming calls regarding Medicaid members in PEND status and those having Re-determination renewal dates.

• Helps members complete necessary paperwork related to either Medicaid eligibility renewal process.

• Assists Medicaid Members in contacting their social worker regarding eligibility issues and follow-up with members to ensure follow through, if allowed by the member's respective state.

• Accurately and timely documents member retention contacts in appropriate database.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

1-3 years

Required License, Certification, Association

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Associate's Degree

Preferred Experience

3-5 years

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.

#PJHPO

#LI-AC1

Pay Range: $16.5 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Candidates For This Position Must Reside In/Near the Erie County Area

Are you passionate about serving others? Do you have established relationships within the community?

Come join our growing Community Engagement team at Molina Healthcare !

Community Outreach and Engagement is more than just participating in events- at Molina, we focus on making an impact on people's lives!

This role involves working with a wide variety of community partners to grow Molina's membership and improve the health and well-being of the Community. Our Specialists work collaboratively with our sales team and across Molina and with each other's regions. You would be responsible for managing events and community relationships in Erie and surrounding counties. You will be in the field engaging with CBO's (Community Based Organizations) 50% or more of the time (Molina reimburses mileage).

This position offers great flexibility and allows for you to manage your territory and schedule to meet business needs. Molina's leadership team leads with empowering you to do what you love best by helping others.

Bilingual (Spanish) Highly Desired!

*Candidates for this position must live in or near the Erie County Area*

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for achieving established goals improving Molina's enrollment growth objectives encompassing Medicaid programs. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages.

• Under limited supervision, responsible for carrying out enrollment events and achieving assigned membership growth targets through a combination of direct and indirect marketing activities, with the primary responsibility of improving the plan's overall -choice- rate. Works collaboratively with other key departments to increase the Medicaid assignment percentage for Molina.

• Works closely with other team members and management to develop/maintain/deepen relationships with key business leaders, community-based organizations (CBOs) and providers, ensuring all efforts are directed towards building membership for Medicaid and related programs. Effectively moves relationships through the -enrollment- pipeline.

• Responsible for achieving monthly, quarterly, and annual enrollment goals, and growth and choice targets, as established by management.

• Schedules, coordinates & participates in enrollment events, encourages key partners to participate, and assists where feasible.

• Works cohesively with Provider Services to ensure providers within assigned territory are aware of Molina products and services. Establishes simple referral processes for providers and CBOs to refer clients who may be eligible for other Molina products.

• Viewed as a -subject matter expert- (SME) by community and influencers on the health care delivery system and wellness topics.

• Delivers presentations, attends meetings and distributes educational materials to both members and potential members.

• Assists with all incoming calls and assist perspective members or members with health access related questions.

• Identify partnerships with key sponsorship opportunities and provide justification to determine Molina's participation.

• Identify and promote Molina's programs out in the community and creates opportunities for employees to participate.

• Responsible for managing their own daily schedule in alignment with department goals and initiatives as assigned by regions.

• Key in the development of SMART goals and provide input on department priorities.

JOB QUALIFICATIONS

Required Education: Bachelor's Degree or equivalent, job-related experience.

Preferred Education: Bachelor's Degree in Marketing or related discipline.

Required Experience:

• Min. 3 years of related experience (e.g., marketing, business development, community engagement, healthcare industry).

• Demonstrated exceptional networking and negotiations skills.

• Demonstrated strong public speaking and presentations skills.

• Demonstrated ability to work in a fast-paced, team-oriented environment with little supervision.

• Must be able to attend public events in outdoor venues in all weather conditions.

• Must be able to sit and stand for long periods.

• Must be able to drive up to 3 hours to attend events. Must be able to lift 30 pounds.

Required License, Certification, Association:

• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Experience:

• Solid understanding of Health Care Markets, primarily Medicaid.

• Previous healthcare marketing, enrollment and/or grassroots/community outreach experience a plus.

• 5 years of outreach experience serving low-income populations.

• 3 - 5 years project management experience, preferably in a health care or outreach setting.

• Experience presenting to influencer and low-income audiences.

• Experience in sales or marketing techniques.

• Fluency in a second language highly desirable.

Preferred License, Certification, Association:

• Active Life & Health Insurance

• Market Place Certified

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.

Key Words: health care, insurance, health insurance, Medicaid, Medicare, health coach, community health advisor, family advocate, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter and public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, Sales, Growth, New York, MCO, Managed Care, ACA, FQHC, Behavioral Health, CHW, Community Health Worker, Equity, DPBH, HMO, SDOH

Pay Range: $16.23 - $35.17 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Claims Examiners.

These positions are remote; however, all candidates must reside in the state of Florida .

Those with Health Insurance call center experience are encouraged to apply. This is an entry level position where you have the opportunity for growth & advancement.

As a Claims Examiner, you will be responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensure that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.

• Manages a caseload of claims. Procures all medical records and statements that support the claim.

• Makes recommendations for further investigation or resolution.

• Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.

• Supports all department initiatives in improving overall efficiency.

• Meets department quality and production standards.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : HS Diploma or GED

Preferred Education : Associate degree or equivalent combination of education and experience

Required Experience : 1-3 years of claims knowledge

Preferred Experience : 3-5 years of claims knowledge

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance

Pay Range: $12.19 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare of Florida is hiring for several Sr. Claims Examiners.

These roles remote, however candidates must reside in Florida.

Ideal candidates will have experience with claims adjudication, claims edits, payout evaluation, front end claims processing, and Excel. QNXT experience a plus!

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.

• Meets and consistently maintains production standards for Claims Adjudication.

• Supports all department initiatives in improving overall efficiency.

• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.

• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues.

• Monitors the medical treatment of claimants. Keeps meticulous notes and records for each claim.

• Manages a caseload of various types of complex claims. Procures all medical records and statements that support the claim.

• Meets department quality and production standards.

• Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education : High School or GED

Preferred Education : Bachelor's Degree or equivalent combination of education and experience

Required Experience : 3-5 years claims processing required

Preferred Experience : 5-7 years claims processing preferred

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.

Key Words: Customer Service, Call Claims, Claims Processing, Adjustment, Claims, Trends, Reports, Denial and Claim, Appeals and Grievances, Data, Follow Up, Medicaid, Medicare, Managed Care, MCO, Codes, Processor, HMO, Bill, Adjust, Healthcare, Health Insurance, Front End Claims, Claims Processing, Excel

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

*This position is remote and employee must reside in Florida*

Job Summary

Analyzes complex business problems and claims issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Provides analytical, problem solving foundation within claims including: definition and documentation, specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• 1-3 years formal training in Business Analysis and/or Systems Analysis

• 1+ years claims background

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: $19.64 - $42.55 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

* We are looking for candidate who can work in PST hours. ***

JOB DESCRIPTION Job Summary Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop solutions. Develops information tools, algorithms, dashboards, and queries to monitor and improve business performance. Creates solutions from initial concept to fully tested production, and communicates results to a broad range of audiences. Effectively uses current and emerging technologies. KNOWLEDGE/SKILLS/ABILITIES

• Extracts and compiles various sources of information and large data sets from various systems to identify and analyze outliers.

• Sets up process for monitoring, tracking, and trending department data.

• Prepares any state mandated reports and analysis.

• Works with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes.

• Implements and uses the analytics software and systems to support the departments goals.

• Must have advanced level working experience with MS Excel for data analysis, data validation and reporting.

• Must have experience working in a healthcare environment.

• Must be able to understand claims process and configuration.

• Act as a tech support to claims teams.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

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: $67,724.8 - $97,362.61 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare