Adjudicator, Provider Claims (Inbound Call Center) Remote in Ohio

About the job

Molina Healthcare is hiring a Provider Claims Adjudicator.  This position is remote; however candidates must live in Ohio.

This position is heavy inbound phone calls from Providers.

This position will be assisting Providers with live claim adjustments, eligibility updates, and/or COBs.

Hours will be Monday through Friday 1130am to 8pm EST.

Highly qualified candidates will have the following experience

• Managed Care / MCO claims experience

• Call center claims experience is highly preferred

• Billing & Appeals and Grievances

• Provider Customer service and/or Member experience

• Salesforce, QNXT, PEGA

• Claim Shark

Essential Job Duties

• Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.

• Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution.

• Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues.

• Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.

• Assists in reviews of state and federal complaints related to claims.

• Collaborates with other internal departments to determine appropriate resolution of claims issues.

• Researches claims tracers, adjustments, and resubmissions of claims.

• Adjudicates or readjudicates high volumes of claims in a timely manner.

• Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.

• Meets claims department quality and production standards.

• Supports claims department initiatives to improve overall claims function efficiency.

• Completes basic claims projects as assigned.

Required Qualifications

• At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience.

• Research and data analysis skills.

• Organizational skills and attention to detail.

• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.

• Customer service experience.

• Effective verbal and written communication skills.

• Microsoft Office suite and applicable software programs proficient

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

Additional Information

• Job Identification: 2040113
• Job Category: Operations
• Posting Date: 2026-11-03
• Job Schedule: Full time
• Salary Range: $16.40 - $31.97 Hourly *Actual compensation may vary based on geographic location, work experience, education and/or skill level