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Long Beach,
CA
(Click company name to view employer profile and all available
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Career Field |
Claims
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| Insurance
Discipline |
Managed Care
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Assistance |
Not Available
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| Job
Duration |
Full Time |
| Salary
Offered |
Open |
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Molina Healthcare Inc., is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare-including individuals covered under Medicaid, the Healthy Families Program, the State Children's Health Insurance Program (SCHIP) and other government-sponsored health insurance programs. Molina has health plans in California, Michigan, New Mexico, Missouri, Utah, Ohio, Texas and Washington as well as 19 primary care clinics located in Northern and Southern California. The company's corporate headquarters are in Long Beach, California.
CLAIMS SYSTEMS SPECIALIST
POSITION SUMMARY
Conducts analysis around various claims payment processes to ensure accuracy of system configuration and provider payments. Investigates “problem' claims to determine root cause of problem and/or error to address both individual claim resolution and improvement to process to avoid issues from occurring in the future.
Performs and executes various claims process testing requests to ensure desired results are met to support accurate claims payments. Testing categories include but are not limited to the following:
· Benefit, Contract, and Fee Schedule Configuration
· System Enhancements
· Report Validation
· Validation of electronic file loads
PRIMARY RESPONSIBILITIES:
Performs claims systems testing and/or system analysis to ensure accuracy of the system’s configuration and provider payments. Conducts research and root cause analysis on various claims issues to identify and resolve problem payment and configuration concerns.
Developing/creating test plans/scripts with which to provide concise analysis and documented results of the testing outcomes based on configuration changes/updates to support new businesses, benefits, and contracts.
Applies knowledge of claims processing to provide feedback resulting in the improvement of claims processing by identifying configuration improvements and/or when manual interventions and workarounds are required for configuration/system limitations.
Complies with performance standards by completing assignments within the specified time frame. Performs other duties as assigned.
JOB REQUIREMENTS:
5 years claims processing with advancement to auditing / claims analysis / claims research
Level of autonomy/decision making required – Mid-level decision making
Some project management skills
Good oral and written communication skills
Advanced Word and Excel skills
EDUCATION
High School graduate (or GED) / AA preferred
Molina Healthcare is an Equal Opportunity Employer.(EOE). M/F/V/D
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