Claims Resolution Rep I job - Molina Healthcare - Augusta, ME

Responsible for timely review, research and resolution of pended Medicaid claims while achieving all production and quality goals.

Essential Functions

o Processes claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.

o Follows adjudication policies and procedures to ensure proper payment of claims.

o Resolves pended claims based on Medicaid rules and regulation established for final processing.

o Meets established production requirements consistently.

o Supports all departmental initiatives in improving overall efficiency.

Knowledge/Skills/Abilities

o Basic knowledge of Microsoft Office Outlook

o General knowledge of PC

o Good verbal and written communication skills

o Ability to abide by Molina’s policies

o Ability to maintain attendance to support required quality and quantity of work

o Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

o Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Job Qualifications

Required Education:

High School Diploma or equivalent GED

Required Experience:

1-2 years general office experience in a claims environment

Required Licensure/Certification:

None

Preferred Education:

Preferred Experience:

Preferred Licensure/Certification:

None

Additional Description

To all current Molina employees if you are interested in applying for this position please apply through the

intranet

job listing.

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