Claims Adjudicator

Job Summary Join our dynamic team as a Claims Adjudicator! In this role, you will provide essential support in resolving provider claims issues, ensuring accuracy and efficiency in claims processing. You will collaborate with various internal departments to achieve timely resolutions and deliver outstanding customer service to our providers. Key Responsibilities: Support the resolution of provider claims issues, including analyzing claims that have been incorrectly paid. Work collaboratively with member enrollment, provider information management, benefits configuration, and claims processing teams to address provider claim concerns. Respond to incoming calls from providers, providing exceptional customer service and documenting all interactions for future reference. Assist with reviews of state and federal complaints related to claims. Research claims tracers, adjustments, and resubmissions, contributing to a streamlined adjudication process. Adjudicate or readjudicate a high volume of claims efficiently. Identify claims error issues and communicate potential solutions to leadership to help reduce defects. Meet quality and production standards set by the claims department. Contribute to claims department initiatives aimed at improving overall efficiency. Complete additional claims projects as assigned. Qualifications: A minimum of 2 years in a clerical role within a claims or customer service environment, preferably with experience in provider claims investigation and resolution in a managed care organization. Strong research and data analysis skills. Excellent organizational skills and attention to detail. Effective time-management abilities with the capacity to manage multiple tasks and meet internal deadlines. Foundation in customer service with strong verbal and written communication skills. Proficient in Microsoft Office Suite and relevant software programs. We welcome all qualified candidates 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 Actual compensation may vary based on geographic location, work experience, education, and skill level.

Created: 2026-03-12