Lead Adjudicator, Provider Claims (Remote) - closing shift

Company: Molina Healthcare

Ever wondered if your expertise in healthcare claims could truly make a difference, all from the comfort of your own home, no matter where you are in the world? Molina Healthcare is searching for a dynamic, detail-oriented individual to lead our provider claims adjudication team during closing shifts. This isn't just another job; it's a chance to shape processes, mentor a dedicated team, and ensure smooth operations that directly impact provider satisfaction and patient care. If you're ready to bring your leadership and sharp problem-solving skills to a vital, fully remote role, we invite you to explore this unique opportunity.

Overview

As a Lead Adjudicator, Provider Claims at Molina Healthcare, you will play a pivotal role in overseeing our provider claims adjudication activities. You'll be the go-to expert, resolving complex claim issues, investigating discrepancies, and ensuring every claim reaches an appropriate and timely resolution. This is a fully remote, worldwide position, offering the flexibility to work from anywhere while contributing to a crucial aspect of healthcare operations. Your focus will be on the closing shift, providing essential coverage and leadership during those hours.

Key Responsibilities

Workflow Coordination: Manage the daily flow and staffing for claims adjudication, assigning tasks and monitoring team performance against productivity and quality benchmarks.
Escalation Management: Take charge of escalated issues within the claims department, ensuring proper accountability, a sense of urgency, clear communication, and definitive follow-through to resolution.
Troubleshooting: Perform daily claim troubleshooting procedures, providing critical support to the provider claims function whenever needed.
Quality Improvement: Actively participate in or lead efforts to enhance claims processes and policies, driving continuous improvement.
Subject Matter Expertise: Serve as the primary subject matter expert for provider claims, offering valuable feedback to the team and facilitating necessary training sessions.
Efficiency Recommendations: Review and analyze claims deficiencies, then propose effective recommendations to boost efficiencies and improve provider satisfaction.
Customer Service Excellence: Set the benchmark for exemplary customer service within your team, making certain that established claims metrics and compliance measures are consistently met.
Stakeholder Collaboration: Partner effectively with various stakeholders to achieve shared goals and streamline operations.

Requirements

Proven lead level support experience in provider claims adjudication.
Strong understanding of healthcare claims processes and regulations.
Excellent problem-solving, analytical, and research skills.
Demonstrated ability to coordinate workflow, manage escalations, and monitor team performance.
Expertise in training and mentoring staff.
Exceptional communication and interpersonal skills.
Ability to work independently in a remote environment and manage a closing shift schedule.
Commitment to high-quality customer service.

What You'll Gain

The chance to lead a vital function within a major healthcare organization.
A fully remote, flexible work environment, open to candidates worldwide.
Opportunities for professional growth and to significantly impact operational efficiencies.
A collaborative team culture focused on continuous improvement and provider satisfaction.
Competitive compensation and benefits package.