Lead Adjudicator, Provider Claims
Welcome to Molina Healthcare, where our mission is to provide quality healthcare solutions to our members. We are currently seeking a driven and detail-oriented individual to join our team as the Lead Adjudicator for Provider Claims. In this role, you will play a crucial part in ensuring accurate and timely processing of claims from healthcare providers. Our ideal candidate is someone who has a strong understanding of claims adjudication processes and has excellent analytical and leadership skills. Join us in making a positive impact on the lives of our members by ensuring their claims are processed efficiently and accurately.
- Oversee the adjudication process for provider claims, ensuring accuracy and timeliness.
- Train and guide a team of claims adjudicators, providing support and direction as needed.
- Review and analyze claims data to identify trends and areas for improvement.
- Work closely with other departments to resolve complex claims issues and discrepancies.
- Stay updated on industry regulations and policies related to claims processing.
- Develop and implement strategies to improve the efficiency and accuracy of claims processing.
- Conduct regular audits to ensure compliance with company and regulatory standards.
- Collaborate with providers to resolve any concerns or disputes related to claims.
- Maintain accurate and detailed records of claims processing activities.
- Serve as a point of contact for any escalated claims inquiries or issues.
- Continuously monitor and evaluate team performance, providing feedback and coaching as needed.
- Collaborate with cross-functional teams to identify and implement process improvements.
- Keep track of team productivity and ensure all claims are processed within designated timelines.
- Participate in meetings and trainings to stay updated on company policies and procedures.
- Uphold company values and mission, promoting a positive and supportive work environment.
In-Depth Knowledge Of Healthcare Industry: A Lead Adjudicator Should Have A Thorough Understanding Of The Healthcare Industry, Including Medical Coding, Billing, And Claims Processing. This Knowledge Will Enable Them To Effectively Review And Adjudicate Provider Claims.
Experience In Claims Adjudication: The Ideal Candidate Should Have Prior Experience In Claims Adjudication, Preferably In A Leadership Role. This Includes Knowledge Of Industry Guidelines, Procedures, And Regulations Related To Claims Processing.
Strong Analytical And Problem-Solving Skills: As A Lead Adjudicator, The Ability To Analyze Complex Claims Data And Identify Errors Or Discrepancies Is Crucial. The Candidate Should Possess Strong Critical Thinking Skills And The Ability To Make Sound Decisions Based On Evidence And Data.
Leadership And Team Management Skills: This Role Involves Overseeing A Team Of Adjudicators And Ensuring That They Are Performing Their Duties Accurately And Efficiently. The Candidate Should Have Prior Experience In Team Management, Including The Ability To Provide Guidance, Training, And Performance Evaluations.
Excellent Communication And Interpersonal Skills: As A Liaison Between Providers, Members, And Internal Departments, A Lead Adjudicator Should Have Excellent Communication Skills To Effectively Convey Information And Resolve Any Issues. They Should Also Possess Strong Interpersonal Skills To Build And Maintain Relationships With Internal And External Stakeholders.
Communication Skills
Time Management
Multitasking
Attention to detail
customer service
Analytical Thinking
Claims Processing
Team Leadership
Problem-Solving
Medical coding
Insurance Knowledge
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Teamwork
Active Listening
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Lead Adjudicator, Provider Claims in Louisville, KY, USA is $79,000 - $100,000 per year. This may vary depending on the specific company, experience level, and other factors.
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Molina Healthcare is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.
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