Claims Appeals Associate

Job Summary Join our team as a Claims Appeals Associate, where you'll play a vital role in the health care system by supporting claims activities. In this entry-level position, you will review and resolve member and provider complaints, ensuring clear communication of resolutions in compliance with the standards set by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties Input denials and appeals into our information system and organize documentation for further examination. Investigate claims issues using available systems and resources. Ensure that appeals are handled timely and appropriately according to state, federal, and Molina guidelines. Request and acquire medical records or detailed bills as necessary to assist with your research. Craft responses to member appeals and grievances with appropriate language. Escalate relevant appeals for higher-level review when necessary. Generate and send denial letters to members. Support interdepartmental collaboration to coordinate and solve issues efficiently. Maintain statistics and reporting related to appeals and grievances. Work alongside provider and member services to address balance bill and other complaints. Required Qualifications Minimum of 1 year experience in claims or a combination of 1 year in customer/provider service in a health care setting. Strong customer service skills. Excellent organization and time management abilities to handle multiple projects and deadlines. Effective verbal and written communication skills. Proficient in Microsoft Office suite and other related software. Preferred Qualifications Experience in a managed care environment (Medicaid, Medicare, or other government programs) or in a medical office/hospital. Completion of a health care-related vocational program, such as coding or medical assisting. Join us at Molina Healthcare! We offer a competitive benefits and compensation package. Molina Healthcare is proud to be an Equal Opportunity Employer. The pay range for this position is $21.65 - $34.88 per hour, based on factors such as location, experience, and education.

Created: 2026-03-10