Top 31 Claims representative Jobs in Myrtle Beach, Sc

Health Plan Provider Relations Representative
Molina Healthcare —Conway, SC
- $18.85 - $38.69 an hour
- Full-time
- Medical office experience
- Mid-level
- Training & development
- Health insurance
12d
Patient Services Specialist
Little River Medical Center, Inc. —Little River, SC
- Mid-level
- High school diploma or GED
- Medical terminology
- AD&D insurance
- Paid holidays
Quick Apply
12d
Customer Service Representative - State Farm Agent Team Member
Jay Jefferson - State Farm Agent —Myrtle Beach, SC
- $60,000 - $80,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Paid time off
Quick Apply
Compliance Auditor
Oceanic Counseling Group, LLC —Surfside Beach, SC
- From $17.50 an hour
- Full-time
- Background check
- HIPAA
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
2d
Customer Service Representative - State Farm Agent Team Member
Curtis Ward - State Farm Agent —Pawleys Island, SC
- $50,000 - $70,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Paid time off
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Bob Hohman - State Farm Agent —Myrtle Beach, SC
- $45,000 - $55,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- 401(k)
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Wade Davis - State Farm Agent —Myrtle Beach, SC
- $40,000 - $50,000 a year
- Full-time
- Sales
- Office
- Communication skills
- Paid holidays
- Health insurance
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Jamesha Gore-Coggin - State Farm Agent —North Myrtle Beach, SC
- $40,000 - $55,000 a year
- Full-time
- Spanish
- Office
- Communication skills
- Paid holidays
- Health insurance
Quick Apply
Dental Treatment Coordinator
Riccobene Associates Family Dentistry —North Myrtle Beach, SC
- Full-time
- Dental office
- Computer literacy
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Kelly O'Brien - State Farm Agent —Myrtle Beach, SC
- $35,000 - $55,000 a year
- Full-time
- Spanish
- Office
- Communication skills
- Health insurance
- 401(k)
Quick Apply
Multi-Line Representative - State Farm Agent Team Member
Bob Hohman - State Farm Agent —Murrells Inlet, SC
- $55,000 - $75,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Health insurance
- 401(k)
Quick Apply
Account Manager - State Farm Agent Team Member
Jay Jefferson - State Farm Agent —Myrtle Beach, SC
- $75,000 - $100,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Paid time off
Quick Apply
Multi-Line Representative - State Farm Agent Team Member
Wade Davis - State Farm Agent —Myrtle Beach, SC
- $40,000 - $50,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid holidays
- Health insurance
Quick Apply
Multi-Line Representative - State Farm Agent Team Member
Curtis Ward - State Farm Agent —Pawleys Island, SC
- $60,000 - $80,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Health insurance
- Paid time off
Quick Apply
Commercial Lines Account Manager
HUB International —Myrtle Beach, SC
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Wellness program
- Health savings account
Account Representative - State Farm Agent Team Member
Callie Wise - State Farm Agent —North Myrtle Beach, SC
- $40,000 - $60,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Dental insurance
Quick Apply
4d
Commercial Lines Insurance Account Manager, Small Business Unit
HUB International —Myrtle Beach, SC
- Full-time
- English
- Mid-level
- Office
- Continuing education credits
Insurance Account Representative - State Farm Agent Team Member
Charleen Johnson - State Farm Agent —Myrtle Beach, SC
- Full-time
- Office
- Windows
- Computer skills
- Paid time off
Quick Apply

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Health Plan Provider Relations Representative

Molina Healthcare -
Conway, 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.

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Refine Your Search

claims representative jobs in myrtle beach, sc

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Customer Service Representative - State Farm Agent Team Member

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