Claims Examiner III (Lead)

Molina Healthcare Inc., is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare—including individuals covered under Medicaid, the Healthy Families Program, the State Children’s Health Insurance Program (SCHIP) and other government-sponsored health insurance programs. Molina has health plans in California, Indiana, Michigan, New Mexico, Utah and Washington as well as 21 primary care clinics located in Northern and Southern California with future plans in Ohio and Texas. The company’s corporate headquarters are in Long Beach, California.

Job Overview:

Claims Processing and adjudication and claims research when necessary. Must meet and/or exceed qualitative and quantitative production standards. Provides informational resource for employees, assist in training new staff, handle difficult claims and assist Supervisor/Manager with special projects. Specific accountabilities include:

1.Quality Standard-Must meet and Maintain quality standard for position

2.Claims Adjudication-Must meet and consistently maintain production standards

3.Supports all department initiatives in Improving overall efficiency.

4.Teamwork-Rating is based upon individual contribution to both the group and the goals of the group. This area will be rated using the outcome of team goals.

5.Defect reduction-pro-active in identifying error issues and trends and recommending solutions to resolve these issues.

6.Supports Supervisor/Manager with reports, special processes, projects, etc.

7.Interacts with other departments and key vendors to resolve claim issues.

Job Requirements


High School graduate. Some college courses in related areas helpful. 2 Years experience in claims adjudication. Other experience in processing all types of medical claims helpful. Former training background helpful.

Molina Healthcare offers competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE).