Top 36 Claims representative Jobs in Charleston, Sc

Health Plan Provider Relations Representative
Molina Healthcare —Charleston, SC
- $18.85 - $38.69 an hour
- Full-time
- Medical office experience
- Mid-level
- Training & development
- Health insurance
12d
Customer Service Representative - State Farm Agent Team Member
Perry Metzler - State Farm Agent —Charleston, SC
- $40,000 - $70,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Cassie Ballard - State Farm Agent —Charleston, SC
- $45,000 - $80,000 a year
- Full-time
- Office
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply
UNIV - Workers’ Compensation Coordinator - Department of Insurance Services
MUSC —Charleston, SC
- $52,100 - $88,600 a year
- Full-time
- Microsoft Excel
- OSHA
- Mid-level
Multi-Line Representative - State Farm Agent Team Member
Heather Eberlin - State Farm Agent —Charleston, SC
- $75,000 - $110,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid time off
- Parental leave
Quick Apply
MEDICAL BILLING SPECIALIST
NEW HOPE TREATMENT CENTER LLC —North Charleston, SC
- Pass drug screening
- HIPAA
- Research
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Larry Matt - State Farm Agent —Summerville, SC
- $40,000 - $70,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply
Billing Specialist
Guardian Pharmacy of South Carolina —Charleston, SC
- Full-time
- HIPAA
- Research
- Mid-level
- Health savings account
- AD&D insurance
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Allison Ditullio - State Farm Agent —Charleston, SC
- $40,000 - $50,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Paid time off
Quick Apply
Account Manager
Acrisure South Insurance Services, LLC —Mount Pleasant, SC
- Full-time
- 5 years
- Mid-level
- Microsoft Office
- Commuter assistance
- Paid parental leave
Client Service Manager, Government - Charleston, SC
GetWellNetwork, Inc. —Charleston, SC
- $65,000 - $75,000 a year
- Weekends as needed
- Background check
- Military
- Mid-level
- Health insurance
- Cell phone reimbursement
Quick Apply
12d
Insurance Account Representative - State Farm Agent Team Member
Cassie Ballard - State Farm Agent —Charleston, SC
- $45,000 - $80,000 a year
- Full-time
- Office
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply
Multi-Line Representative - State Farm Agent Team Member
Ashby Clark - State Farm Agent —Summerville, SC
- $50,000 - $75,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid holidays
- Paid time off
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Sanja Teagle - State Farm Agent —Charleston, SC
- $30,000 - $45,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- Parental leave
Quick Apply
Commercial Lines Account Manager
HUB International —North Charleston, SC
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Wellness program
- Health savings account
Customer Relations Representative - State Farm Agent Team Member
Mark Ensley - State Farm Agent —Summerville, SC
- $42,000 - $60,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply
Commercial Lines Insurance Account Manager, Small Business Unit
HUB International —North Charleston, SC
- Full-time
- English
- Mid-level
- Office
- Continuing education credits
Customer Service Representative - State Farm Agent Team Member
Mike Stuckey - State Farm Agent —North Charleston, SC
- $40,000 - $55,000 a year
- Full-time
- Spanish
- Office
- Communication skills
- Paid holidays
- 401(k)
Quick Apply
Multi-Line Representative - State Farm Agent Team Member
Perry Metzler - State Farm Agent —Charleston, SC
- $40,000 - $70,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid time off
- Opportunities for advancement
Quick Apply
Business Development Representative - State Farm Agent Team Member
Caitlan Schanne - State Farm Agent —Ladson, SC
- $45,000 - $75,000 a year
- Full-time
- Office
- Business development
- Communication skills
Quick Apply

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Health Plan Provider Relations Representative

Molina Healthcare -
Charleston, SC

Apply Now

Job Details

Full-time
$18.85 - $38.69 an hour
12 days ago

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

_*Remote and must live in South Carolina*_

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.
Role requires 60%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).

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: $18.85 - $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

claims representative jobs in charleston, sc

Health Plan Provider Relations Representative

Customer Service Representative - State Farm Agent Team Member

Customer Service Representative - State Farm Agent Team Member

UNIV - Workers’ Compensation Coordinator - Department of Insurance Services

Multi-Line Representative - State Farm Agent Team Member

MEDICAL BILLING SPECIALIST

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Billing Specialist

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Multi-Line Representative - State Farm Agent Team Member

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