Top 4105 Claim Resolution Representative Jobs

Representative, Health Plan Provider Relations - Remote Must reside in NY
Molina Healthcare —New York, NY
- $19.84 - $46.42 an hour
- Full-time
- Remote
- Medical office experience
- Mid-level
- Travel
- Health insurance
Billing/AR Representative - Remote
EYECARE SERVICES PARTNERS MANAGEMENT, LLC —Remote
- $19 - $25 an hour
- Full-time
- Remote
- Basic math
- Mid-level
- Windows
- Paid holidays
- Disability insurance
Quick Apply
Long Term Care Benefit Claim Specialist
Mutual of Omaha —Remote
- $24 - $28 an hour
- Email
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- Customer service
- Mid-level
- Experience equivalent to degree accepted
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- 401(k)
Customer Service Representative - Part Time (Remote)
GETIX HEALTH —Houston, TX
- $17 an hour
- Part-time
- Remote
- Spanish
- HIPAA
- English
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Billing and Follow Up Representative-I (Hospital Medical Billing Follow-up-Medicare & Medicare Advantage Payor-FL) - PFS (Remote)
Trinity Health —Farmington Hills, MI
- $17.15 - $25.73 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
AR Research and Resolution Representative
US Acute Care Solutions —Remote
- $14.53 - $26.88 an hour
- Overtime
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- Word processing
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- Basic math
- Paid parental leave
- Health savings account
6d
Workers Compensation Claims Representative | Dedicated Client | Multiple Jurisdictions & Licensing Required | Remote - Central or Eastern Time Zone
Sedgwick —Charlotte, NC
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- High school diploma or GED
- Health savings account
- Disability insurance
Liability Claims Representative | GL, BI, Auto & Premise Liability Experience | Nationwide jurisdictions | Home State Licensing | Remote
Sedgwick —North Carolina
- Full-time
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- Mid-level
- 3 years
- High school diploma or GED
- Health savings account
- Disability insurance
Licensed Insurance Customer Care Representative (P&C Producer License Required) - Farmers Workplace
Farmers Insurance Group —Washington State
- $21.45 - $38.61 an hour
- Monday to Friday
- Remote
- High school diploma or GED
- In-person
- 1 year
- Paid training
- Paid parental leave
Work from Home: Customer Service Representative (Healthcare)
Sagility —Remote
- $14 - $15 an hour
- Weekends as needed
- Remote
- 18 years or older
- Research
- High school diploma or GED
- Paid training
- Disability insurance
Personal injury, property damage, and tort-based claims attorney
Talent Search PRO —Los Angeles, CA
- $150,000 - $200,000 a year
- Full-time
- Hybrid work
- Writing skills
- Mid-level
- 3 years
Quick Apply
Medicare Accounts Receivable Billing Representative
Total Orthopedics & Sports Medicine —Syosset, NY
- $25 - $28 an hour
- Full-time
- Mid-level
- Office
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
8d
Material Damage Appraiser
NODAK INSURANCE COMPANY —Devils Lake, ND
- Full-time
- Background check
- Clean driving record
- 5 years
- Health savings account
- Disability insurance
Civil Litigation Attorney
Reding & Pilney, LLC —Lake Elmo, MN
- $75,000 - $130,000 a year
- Full-time
- Writing skills
- Mid-level
- Administrative experience
- Health savings account
- Paid holidays
Quick Apply
Claims Representative
Seaview Insurance Company —Phoenix, AZ
- $55,000 - $75,000 a year
- 8 hour shift
- Hybrid work
- Background check
- Office
- Bachelor's degree
- Health savings account
- Disability insurance
Quick Apply
City Attorney
City of Nixa —Nixa, MO
- $149,090 - $162,508 a year
- Full-time
- Background check
- Management
- Word processing
- Health savings account
- Health insurance
Quick Apply
Ag Specialty Appraiser
FBL Financial Group, Inc. —Sioux Falls, SD
- Customer service
- 5 years
- Travel
- Paid holidays
- Disability insurance
6d
Mass Tort Litigation Attorney
Krentsel Guzman Herbert LLP. —New York, NY
- $90,000 - $130,000 a year
- Full-time
- Writing skills
- Mid-level
- Analysis skills
- Paid holidays
- Health insurance
Quick Apply
Director of Human Resources
St Coletta of Wisconsin Inc —Jefferson, WI
- Experience working with individuals with disabilities
- 5 years
- Master's degree
Quick Apply
Workers Compensation Claims Representative
Wisconsin Municipal Mutual Insurance Company —Wisconsin
- Full-time
- Hybrid work
- Customer service
- Mid-level
- Residential
- Health savings account
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Quick Apply

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Representative, Health Plan Provider Relations - Remote Must reside in NY

Molina Healthcare -
New York, NY

Apply Now

Job Details

Full-time
$19.84 - $46.42 an hour

Benefits

Health insurance

Qualifications

Customer communication
Managed care
Managed care organization experience
Medical office experience
Schedule management
Health insurance knowledge
Productivity software
Cross-functional collaboration
Cross-functional communication

Full Job Description

JOB DESCRIPTION Job Summary

Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures.

Essential Job Duties

Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.
Collaborates directly with the plan’s external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship.
Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.
Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding).
Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs).
Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.).
May provide training and support to new and existing provider relations team members as appropriate.

will require to travel at least once a week subject to change.

Required Qualifications

At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience.
General understanding of the health care delivery system, including government-sponsored health plans.
Organizational skills and attention to detail.
Ability to manage multiple tasks and deadlines effectively.
Interpersonal skills, including ability to interface with providers and medical office staff.
Ability to work in a cross-functional highly matrixed organization.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc.
Experience delivering training and facilitating educational presentations.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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

Pay Range: $19.84 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

Claim Resolution Representative jobs

Representative, Health Plan Provider Relations - Remote Must reside in NY

Billing/AR Representative - Remote

Long Term Care Benefit Claim Specialist

Customer Service Representative - Part Time (Remote)

Billing and Follow Up Representative-I (Hospital Medical Billing Follow-up-Medicare & Medicare Advantage Payor-FL) - PFS (Remote)

AR Research and Resolution Representative

Workers Compensation Claims Representative | Dedicated Client | Multiple Jurisdictions & Licensing Required | Remote - Central or Eastern Time Zone

Liability Claims Representative | GL, BI, Auto & Premise Liability Experience | Nationwide jurisdictions | Home State Licensing | Remote

Licensed Insurance Customer Care Representative (P&C Producer License Required) - Farmers Workplace

Work from Home: Customer Service Representative (Healthcare)

Personal injury, property damage, and tort-based claims attorney

Medicare Accounts Receivable Billing Representative

Material Damage Appraiser

Civil Litigation Attorney

Claims Representative

City Attorney

Ag Specialty Appraiser

Mass Tort Litigation Attorney

Director of Human Resources

Workers Compensation Claims Representative

I want to receive the latest job alert for Claim Resolution Representative

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