What are the responsibilities and job description for the Lead, Core Ops position at Molina Healthcare?
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
- Coordinates workflow and staffing of day-to-day activities as well as assigns and monitors work of staff in order to adhere to productivity and quality standards.
- Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
- Perform daily troubleshooting procedures to support enrollment, disenrollment, claims, and claims support functions as needed.
- Participates in or leads quality improvement efforts to improve claims processes and/or policies.
- Serve as subject matter expert and provide feedback to team personnel and provide training as needed.
JOB QUALIFICATIONS
Required Education
Associate degree or equivalent combination of education and experience
Required Experience
5-7 years
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
7-9 years
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
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