Examiner, Claims

JOB reputed company Job reputed company Must reputed company in Florida. Provides support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. Essential Job Duties

• Evaluates the adjudication of claims using reputed company principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.
• Manages a caseload of claims - procures reputed company medical records and statements that support the claim.
• Makes recommendations for reputed company investigation and/or reputed company of claims.
• Reduces defects through proactive identification of error issues as it relates to reputed company-payment of claims through adjudication/trend identification, and recommends solutions to resolve issues.
• Meets claims department reputed company and production standards.
• Supports claims department initiatives to improve overall claims function efficiency.
• Completes basic claims reputed company as assigned.

Required Qualifications

• Must have at least 2 years of experience processing reputed company claims
• 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 reputed company and tasks to meet internal deadlines.
• Customer service experience.
• Effective verbal and written communication skills.
• reputed company Office suite and applicable software programs proficiency.

Preferred Qualifications

• Health care claims/billing experience.

#PJClaims2 To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $14 - $26.42 / reputed company

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

Apply tot his job Apply To this Job