Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.
• Ensures execution of claim handling strategies; including appropriate determination of coverage, processing guidelines and metrics.
• Coordinates work flow and staffing of day-to-day activities as well as assigns and monitors work of staff in order to adhere to productivity and quality standards.
• Reviews and analyzes claim reports to identify and address trends. Recommends strategies to correct adverse trends.
• Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
• Reviews and documents recommendations for claim disposition; including evaluation, negotiation and settlement of claims in excess of staff authority levels.
• Responsible for compiling and submitting daily, weekly and monthly departmental reports to management.
• Serve as subject matter expert and provide feedback to team personnel and provide training as needed..
Associate's Degree or equivalent combination of education and experience
Bachelor's Degree or equivalent combination of education and experience
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.