Claims Adjudicator

JOB DESCRIPTION Join our team as a Claims Adjudicator and play a vital role in supporting provider claims adjudication activities. In this position, you will address claim issues from providers, research and investigate claims, and ensure proper resolution in a fast-paced call center environment. Essential Job Duties Handle incoming calls from providers to resolve claims inquiries, providing top-notch customer service and documenting all interactions. Support the resolution of claims issues, including identifying incorrect payments, working closely with operational teams for efficient resolution. Collaborate with member enrollment, provider information management, benefits configuration, and claims processing teams to address claim issues effectively. Assist with reviews of state and federal complaints related to claims. Investigate claims tracers, adjustments, and resubmissions to ensure accuracy. Adjudicate or re-adjudicate a high volume of claims promptly. Promote defect reduction by identifying claims error issues and communicating potential solutions to leadership. Meet departmental quality and productivity standards while supporting initiatives that enhance overall claims function efficiency. Complete basic claims projects as assigned. Required Qualifications Minimum of 2 years of experience in a clerical role within claims or customer service, including experience in provider claims investigation and resolution within a managed care organization. Strong research and data analysis capabilities. Excellent organizational skills and attention to detail. Effective time-management skills to handle multiple projects simultaneously and meet deadlines. Proven customer service experience. Strong verbal and written communication skills. Proficiency in Microsoft Office suite and relevant software programs. If you are passionate about making a difference and meet the qualifications, we encourage you to apply. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY. Compensation may vary based on location, experience, education, and skills.

Created: 2026-03-04