JOB DESCRIPTION

Job Summary

Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

Manages and develops a team focused on meeting or exceeding established performance targets. Targets may be based upon plans, federal or state requirements as dictated.

Proactively plans for daily priorities as well as responds to new priorities within the organization and opportunities assigned from upper management.

Responsible for compiling and submitting daily, weekly, and monthly departmental reports to management.

Acts as a technical expert in handling complaints and other escalated issues from internal and external customers.

Supports claims performance improvement via participation in special claims initiatives.

Participates in and support the development of strategies to meet business needs.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

7-9 years

Preferred License, Certification, Association

Certification in Training and Development preferred for manager overseeing Training unit

Internal Audit Certification a plus for manager overseeing Regulatory Quality Audit unit

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.