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  • Claims Adjudicator II

    Unite Here Health 4.5company rating

    Remote adjudicator job

    UNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity! The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes. This position utilizes multiple systems in order to perform the day-to-day functions of processing medical, disability, vision and dental claims, as well as, provider and member driven inquiries. ESSENTIAL JOB FUNCTIONS AND DUTIES * Screens claims for completeness of necessary information * Verifies participant/dependent eligibility * Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents * Codes basic information and selects codes to determine payment liability amount * Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered * Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers * Handles the end to end process of Medicare Secondary Payer (MSP) files * Processes Personal Injury Protection (PIP) claims * Requests overpayment refunds, maintains corresponding files and performs follow-up actions * Handles verbal and written inquiries received from internal and external customers * Processes Short Term Disability claims * Adjudicates claims according to established productivity and quality goals * Achieve individual established goals in order to meet or exceed departmental metrics ESSENTIAL QUALIFICATIONS * 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment * Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits * Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and it's related processes * Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes * Fluency (speak and write) in Spanish, preferred Salary range for this position: Hourly $20.36 - $24.97. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location. Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) Fully Remote, after 1-week training onsite in Oak Brook, IL. (Travel and Lodging paid for by UHH) We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP). #Remote
    $20.4-25 hourly Auto-Apply 34d ago
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  • Hearing Officer (Review Examiner II)

    State of Massachusetts

    Remote adjudicator job

    The Department of Transitional Assistance (DTA) is seeking qualified applicants for the position of Hearings Officer. The ideal candidate will conduct Administrative Disqualification Hearings in accordance with applicable laws and regulations and issue fair, impartial decisions within established regulatory time frames. DTA attracts people passionate about public service, who love to work in a fast-paced environment and who are committed to diversity, equity, and inclusion. Duties and Responsibilities (these duties are a general summary and not all inclusive): * Structure and clearly explain procedures that govern hearings. * Control testimony (including evidentiary rulings) and identify and mark exhibits. * Maintain substance and appearance of impartiality and demonstrate patience and courtesy toward all parties. * Assure the record is fully developed, and all issues adequately addressed. * Render a written decision based on relevant regulations and standards within the time frames required by law. * Conduct statewide telephonic, videoconference, and in-person hearings as assigned. * Make and store digital recordings of hearings following established procedures. * Establish jurisdiction and identify relevant issues. * Summarize evidence and identify, mark, document, and store all exhibits. * Make appropriate findings of material facts, apply law to facts, and reach reasonable legal conclusions based on relevant regulations and standards. * Sign and submit error-free, properly formatted decisions and issue clear, complete orders to the Department. * Follow assigned procedures governing reschedules, continuances, reopenings, dismissals, and withdrawals. * Confer with DTA management and other agency personnel to provide or exchange information and resolve problems. * Render decisions within 30 days of the hearing date or 5 business days prior to the decision due date, whichever comes first. Required Qualifications * Ability to understand, explain, and apply the laws and rules governing assigned unit activities. * Ability to read and interpret legal documents such as decisions, briefs, and opinions. * Ability to analyze and determine the applicability of data, to draw appropriate conclusions, and make appropriate recommendations. * Ability to gather information through questioning individuals and examining records. * Ability to make decisions and act quickly in stressful situations. * Ability to determine the proper format and procedure for assembling items of information. * Ability to maintain accurate records and prepare general reports. * Ability to communicate effectively in oral and written expression. * Ability to prioritize work in order to complete all assigned tasks in a timely manner. * Ability to work independently. * Ability to exercise discretion in handling confidential information. * Ability to exercise sound judgment. * Ability to establish and maintain harmonious working relationships and deal tactfully and respectfully with others. * Ability to travel throughout the state using their own mode of transportation on a daily basis. * Ability to use all necessary functions of a laptop computer to compose decisions and store information in an orderly manner. * Ability to work remotely while maintaining productivity, accuracy, and accountability. Preferred Qualifications: * Knowledge of the laws, rules, regulations, policies, procedures, etc. governing assigned unit activities. * Knowledge of the state law governing administrative hearings. * Knowledge of the legal procedures involved in conducting public and executive hearings. * Knowledge of the laws and rules governing the presentation and admissibility of evidence. * Knowledge of reference and related sources available for legal research. * Knowledge of the types and uses of agency forms. * Given the population served, bilingual or multilingual fluency. Agency Mission: The Department of Transitional Assistance (DTA) is the state agency responsible for administering public assistance programs to low-income residents of the Commonwealth. DTA is committed to providing a high level of service to all those in need. The mission of the Department is to assist and empower low-income individuals and families to meet their basic needs, improve their quality of life, and achieve long term economic self-sufficiency. DTA serves one out of every six people in Massachusetts - including working families, children, elders, and people with disabilities. Our services include food and nutritional assistance, economic assistance, and employment supports. Learn more about our services and programs visit: **************** NOTE: Selected candidates must complete a language proficiency examination which will test reading comprehension, conversational, and writing skills in English and the specified second language. TO APPLY: Please upload both the Resume and Cover Letter for this position. First consideration will be given to those applicants who apply within the first 14 days. About The Department of Transitional Assistance: The Department of Transitional Assistance (DTA) is the state agency responsible for administering public assistance programs to low-income residents of the Commonwealth. DTA is committed to providing a high level of service to all those in need. The mission of the Department is to assist and empower low-income individuals and families to meet their basic needs, improve their quality of life, and achieve long-term economic self-sufficiency. DTA serves one out of every seven people in Massachusetts - including working families, children, elders, and people with disabilities. Our services include food and nutritional assistance, economic assistance, and employment support. Learn more about our services and programs visit: **************** Pre-Hire Process: A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit **************************** Education, licensure, and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines. Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website. If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the ADA Reasonable Accommodation Online Request Form. For questions, please contact the Office of Human Resources at ************** and select option #4. First consideration will be given to those applicants that apply within the first 14 days. Minimum Entrance Requirements: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional experience, the major duties of which included the adjudication, examination and/or review of claims, benefits and/or taxes; the practice of law; labor relations work; claims investigation or adjustment work; credit management or credit investigation work; or (B) any equivalent combination of the required experience and the substitutions below. Substitutions: I. A Bachelor's or higher degree with a major in law may be substituted for a maximum of three years of the required experience.* II. A Bachelor's or higher degree with a major other than in law may be substituted for a maximum of two years of the required experience.* * Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed. NOTE: Educational substitutions will only be permitted for a maximum of three years of the required experience. Salary placement is determined by a combination of factors, including the candidate's years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division's Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range. Comprehensive Benefits When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future. Want the specifics? Explore our Employee Benefits and Rewards! An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.
    $72k-108k yearly est. 21d ago
  • Employment Law (DEFENSE)

    Drannek Consulting

    Remote adjudicator job

    Our client, a prominent national law firm specializing in representing management in labor and employment matters, is seeking a Special Counsel. This role is ideal for experienced employment attorneys seeking flexibility while maintaining a robust litigation practice. About the Role: This primarily remote position centers on handling administrative charges, attorney demand letters, and employment litigation for a broad client base, including clients with Employment Practices Liability Insurance (EPLI). In this role, you will lead case strategy, oversee attorneys and support staff, and manage matters from inception to resolution, including drafting, depositions, hearings, and trials. While travel is minimal, some local appearances may be required. You will work with a collaborative team of partners and attorneys, supported by dedicated paralegals and a shared secretarial pool. The focus is on delivering high-quality legal work efficiently, without the burden of business development requirements or non-billable hour pressure. Key Responsibilities: Lead and manage single-plaintiff litigation matters and administrative agency proceedings. Draft and review pleadings, legal memoranda, and client communications. Conduct depositions, represent clients at hearings, mediations, and trials. Supervise junior attorneys and support staff. Collaborate with senior attorneys and firm leadership on legal strategy. Occasionally assist with class action, PAGA, or other complex employment matters. Qualifications: JD from an ABA-accredited law school Minimum 7+ years of employment law and litigation experience Active bar membership in good standing in at least one U.S. jurisdiction. Strong writing, analytical, and communication skills Ability to work independently in a remote environment. Preferred: Experience at a law firm Familiarity with EPLI-covered matters Admission to the California, Washington, or Arizona bar
    $21k-33k yearly est. 8d ago
  • Adv-Legal Data & Operations

    Fedex 4.4company rating

    Remote adjudicator job

    Establish financial transparency, operational efficiency and reporting capabilities to support strategic decision-making and resource optimization across the legal department. ESSENTIAL JOB DUTIES/RESPONSIBILITIES: 1. Manage department budget: planning, tracking and expense analysis 2. Partner with Finance to identify cost-saving opportunities 3. Oversee invoicing and payment processes for legal services 4. Define Key Performance Indicators (KPI) for tech adoption and Return on Investment (ROI). 5. Create dashboards for system performance and user satisfaction 6. Track vendor performance and ensure contract compliance 7. Support technology procurement and cost analysis 8. Assist in developing strategic goals for the legal department 9. Prepare reports and metrics for performance monitoring 10. Provide data-driven insights for leadership decisions 11. Maintain templates and best practices repository 12. Support onboarding and operational training 13. Perform other duties as required Disclaimer: This job description is general in nature and is not designed to contain or to be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job. QUALIFICATIONS: * Bachelor's degree in Finance, Accounting, Business Administration, Legal Studies or related field or equivalent experience plus five (5) years' experience in financial management, budgeting and forecasting * Master's degree or certifications in Legal Operations, Project Management Professional (PMP) and/or Financial Analysis, preferred * Familiarity with eBilling systems and vendor management * Strong data analysis and dashboard development skills * Ability to work independently and drive operational improvements * Strong KPI reporting and analytics skills * Strong verbal and written communication skills, necessary to communicate with all levels of management * Interpersonal skills necessary to work professionally with all levels of the organization and build collaborative working relationships Pay Transparency: The compensation listed reflects the pay range or rate of pay reasonably expected for this posted position at the posted location(s). If this opportunity includes multiple job levels, the pay information represents the minimum and maximum range for all levels. Actual pay is determined by job-related factors permitted by law and relevant to the position, such as experience, tenure, market level, pay at the location for this job, performance, schedule, and work assignment. Eligible employees offered health, vision, and dental insurance, employee assistance program, personal/sick paid time, 401(k) retirement savings plan, bonus potential, tuition reimbursement, adoption assistance, 2 weeks paid parental leave, paid bereavement, employee discounts, 6.67-13.34 hours vacation per month based on service time, 8 paid holidays. Pay Range: $83,799.00 - $160,894.00 per year Colorado Pay Ranges: Springfield $83,799 - $134,079; Colorado Springs, Grand Junction $89,665 - $143,465; Henderson, Mead $94,693 - $151,509; Gypsum $100,559 - $160,894 Illinois Pay Ranges: East Moline, Effingham, Kankakee, Lincoln, Quincy, Rockford $89,665 - $143,465; Aurora, Bolingbrook, Chicago Heights, Des Plaines, Elmhurst, Forest View, Joliet, Schaumburg, Summit-Argo, Zion $100,559 - $160,894 New York Pay Ranges: Plattsburgh, Buffalo, Watertown, North Chili, East Syracuse, Nichols $89,665 - $143,465; Nichols $94,693 - $151,509; Bethpage, Montgomery, West Babylon $100,559 - $160,894 Preferred Qualifications: Pay Transparency: Posting Date: 01/08/26. Will remain posted 60 days (unless filled/canceled sooner). Current FedEx employees apply at enterprisecareers.fedex.com. Others apply at careers.fedex.com. Pay: Additional Details: While this is a remote position, the successful candidate must reside within 50 miles of a FedEx Freight location within the continental U.S. FedEx Freight is an Equal Opportunity Employer, including disabled and veterans. * Know Your Rights * Pay Transparency If you have a disability and you need assistance in order to apply for a position with FedEx Freight, please call ************ or e-mail at ADAAssistance@freight.fedex.com. FedEx Freight will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
    $46k-64k yearly est. 4d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare Inc. 4.4company rating

    Adjudicator job in Cleveland, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $21.7-38.4 hourly 17d ago
  • Legal Co-Op Spring 2026

    Watts Heating and Hot Water Solutions

    Remote adjudicator job

    We're Watts. Together, we're reimagining the future of water. We feel proud every day about what we do. We're all part of the same crucial mission, no matter what function we support -- it's to provide safe, clean water for the world, and to protect our planet's most valuable resource. What we do: For 150 years, Watts has built best-in-class products that are trusted by customers in residential and commercial settings across the world. We are at the forefront of innovation, working with cutting-edge technology to provide smart and connected, sustainable water solutions for the future. Watts is a leading brand with a quality reputation - and we have a dynamic future ahead. The Watts Co-op Program is your chance to bring what you've learned in the classroom to life! You'll dive into real-world projects, gaining hands-on experience while learning how business really works from the inside. During the program, you'll get to roll up your sleeves and make an impact on day-to-day operations. Plus, you'll have tons of opportunities to network with passionate professionals across manufacturing, engineering, corporate and more-sparking new ideas through cross-department collaboration. It's all about expanding your skills, challenging yourself, and exploring where your ambitions can take you! What You'll Do The Legal Intern will support the Legal Department's attorneys by assisting with legal research, document preparation, and case management related to employment law, product liability, and general corporate matters. This role provides an excellent opportunity to gain hands-on experience in a dynamic, in-house legal environment and interact with various departments in the Company. This role is ideal for someone looking to gain practical legal experience in an in-house setting and contribute to a supportive legal team. Key Responsibilities: Legal Research: Conduct and organize research on statutes, regulations, and case precedents to support attorneys in advising the human resources and other teams in the Company and managing product standards and related litigation. Compliance Assistance: Help in developing and implementing policies and procedures that ensure compliance with applicable laws and regulations and foster a fair workplace environment. Training Support: Assist in the training of employees on legal compliance and employment law matters. General Corporate Support: Assist with various general corporate matters, including corporate governance and subsidiary organizational matters. Who You Are Current student (sophomore, junior or senior status). Pursuing a degree in legal studies, paralegal studies, or a related field. Excellent written and verbal communication skills. Proficiency with Microsoft Office Suite or related software. Knowledge of legal terminology and principles. Familiarity with legal research tools, such as Westlaw and Practical Law. Ability to work independently and as part of a team. Commitment to maintaining confidentiality and ethical standards. Passionate about your work, with a genuine desire to contribute meaningfully and make an impact. Demonstrated commitment to integrity and respect in interactions with others, fostering a positive and inclusive work environment. Strong sense of accountability, taking ownership of tasks and following through on commitments. Must be authorized to work in the United States and not require sponsorship now or in the future. What's In It for You People-First Culture - Enriching and caring for people is at the core of who we are; this includes executing our collaborative work strategy, and providing you with meaningful career growth opportunities, a positive and safe work environment, and affirmation that you are heard, valued, and respected. Flexible PTO Policy - Work-life balance is important at Watts and our interns receive one (1) hour of flexible PTO for every thirty (30) hours worked. Your flexible PTO can be utilized for any type of absence in accordance with Watts' PTO policy. Paid Holidays - Celebrate the holidays with your loved ones and still get paid! You will receive the following paid holidays off during your time as an Intern with Watts. Where a holiday falls during the weekend, it will be observed on an adjacent weekday. Lunch and Learns - Throughout your internship, there will be opportunities for you to sign up to learn and network with some of the key strategic leaders and thought partners within our core operating model! Sustainability - For five years in a row, Watts has been named one of "America's Most Responsible Companies" by Newsweek. Join our journey as we continue to distinguish Watts as a responsible and committed corporate citizen. Working Conditions While performing the job duties, you will be working in an office environment. You will be required to work in the office at the Watts North Andover location three days per week (Monday - Wednesday) and can work remotely two days per week (Thursday and Friday). *Physical Requirements The employee is required to sit, stand, walk, and use hands to handle objects and other devices. Specific physical abilities required for this position include: Ability to remain seated at a desk or workstation for extended periods. Ability to perform repetitive tasks like typing on a keyboard or using a mouse for extended periods. Physical ability to move around the office, organize or transport files, packages, or other office-related materials. Ability to read documents, use a computer, and perform data entry tasks. Ability to communicate clearly with coworkers, particularly in meetings or phone calls. Ability to operate standard office equipment such as computers, printers, phones, and copiers. Ability to occasionally lift and carry light objects (up to 15-20 pounds), such as office supplies, documents, or small equipment. Watts is committed to equal employment opportunity. We follow a policy of administering all employment decisions and personnel actions without regard to race, color, religion, creed, sex, pregnancy, national origin, sexual orientation, age, physical or mental disability, genetic disposition or carrier status, marital status, military or veteran status, minorities, or any other category protected under applicable federal, state, or local law. Consistent with the obligations of state and federal law, Watts will make reasonable accommodations for qualified individuals with disabilities. Any employee who needs a reasonable accommodation should contact Human Resources. Watts in it for you: Please note that the following benefits apply only to permanent roles and do not apply to internship roles. Competitive compensation based on your skills, qualifications and experience Comprehensive medical and dental coverage, retirement benefits Family building benefits, including paid maternity/paternity leave 10 paid holidays and Paid Time Off Continued professional development opportunities and educational reimbursement Additional perks such as fitness reimbursements and employee discount programs Learn more about our benefit offerings here: ********************************* How we work: At Watts, our culture is team-oriented and supportive. Employees here genuinely care about the quality of their work, and about each other. Our people are the heart of who we are and contribute to our longevity and continued success. And this is a place where you can have a big career. No matter your role, there are opportunities for learning and development, and your daily contributions make a meaningful impact on the lives of people who use our products and on the future of water. Watts is committed to equal employment opportunity. We follow a policy of administering all employment decisions and personnel actions without regard to race, color, religion, creed, sex, pregnancy, national origin, sexual orientation, age, physical or mental disability, genetic disposition or carrier status, marital status, military or veteran status, minorities, or any other category protected under applicable federal, state, or local law. Consistent with the obligations of state and federal law, Watts will make reasonable accommodations for qualified individuals with disabilities. Any employee who needs a reasonable accommodation should contact Human Resources.
    $65k-95k yearly est. Auto-Apply 43d ago
  • 2025-2026 SY: Hearing Officer- Long Term Suspension (0.2 FTE)

    Santa Fe Public Schools 4.5company rating

    Remote adjudicator job

    Part-Time Employment Additional Information: Show/Hide Title: Hearing Officer - Long Term Suspension Work Unit: Family and Community Engagement Reports To: Chief Family and Community Engagement Officer Contract Length: 10 months Pay Schedule: Principal/Assistant Principal Overtime Status: Exempt Hours: Variable Union Status: NEA Licensure: Pre K-12 Administrative Note: All positions with Santa Fe Public Schools require a post-offer/pre-employment background check. Some positions have additional requirements as established by federal or state rules and regulations. General Function: The Long-Term Suspension Hearing Officer serves as an impartial adjudicator for student discipline cases that may result in a long-term suspension or expulsion. The position ensures hearings are conducted in alignment with federal and state law, district policy, and due process requirements. The Hearing Officer reviews evidence, hears testimony from all parties, and issues written findings and recommendations to the Superintendent or designee. Education/Training/Experience: Minimum: Master's Degree or National Board Certification and NMPED Level 3B Administrator's License Preferred: Bilingual: English-Spanish Knowledge/Skills and Abilities: * Strong understanding of New Mexico Public Education Department regulations and SFPS policies related to student discipline. * Ability to maintain impartiality, confidentiality, and professionalism in sensitive situations. * Exceptional oral and written communication skills. * Proficiency in Microsoft Office and Google Suite. * Strong organizational skills and attention to detail. * Ability to manage multiple cases simultaneously under tight timelines. * Conflict resolution, negotiation, and mediation skills. * Experience as a principal or assistant principal related to student discipline at the school site. Essential Job Functions: Performs all functions in accordance with established policies, procedures, safety and environmental regulations, and facility and computer security protocols. Duties are subject to change as needed to meet organizational needs. Current essential responsibilities include, but are not limited to, the following: * Serve as the impartial hearing officer in long-term suspension hearings. * Schedule and conduct hearings in compliance with legal and policy timelines. * Review and evaluate evidence, witness statements, and relevant documentation. * Ensure that all parties understand hearing procedures and their rights. * Facilitate testimony from students, parents/guardians, school staff, and other witnesses. * Maintain an accurate and complete record of proceedings. * Prepare and issue timely written findings of fact, conclusions, and recommendations. * Collaborate with district administrators and legal counsel as appropriate. * Maintain confidentiality of all student and case information. * Stay current on applicable laws, regulations, and best practices in student discipline. Salary Range and Benefits: $15,000+ (At 0.2 FTE) Resources Used in Performing Job Include (but are not limited to): Standard office equipment and software platforms such as Microsoft Office (Word, Excel, PowerPoint) and the Google Suite. Telephone, fax, copier, computer, stamp machine, badge machine, calculator. Physical/Cognitive Requirements: Regularly required to stand and move throughout a room and/or facility. Communicates verbally and electronically. Uses hands to handle or feel objects, tools, or controls and reach with hands and arms. Frequently required to stoop, kneel, crouch, and/or crawl. Occasionally required to sit, climb, balance, and drive. May have occasion to perform heavy lifting up to 40 pounds. Specific vision abilities required include close vision, distance vision, color vision, and the ability to adjust focus. Must possess and maintain a valid driver's license and private automobile. Some evening or weekend work and travel may be required. Environmental Conditions: Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT) and extensive personal computer and phone usage. Work from home may be required. Some sitting, standing, bending and reaching may be required. Some occasional travel is required for meetings and conferences. Personal Accountability: * Demonstrates reliability as evidenced by attendance records and punctuality. * Properly notifies supervisor and/or designee of absences or tardiness. * Begins and completes work within the allotted time. * Consistently appears in attire appropriate to the work environment. * Demonstrates skill in the use of equipment including its capabilities, limitations and appropriate/ special application. * Protects the district's resources through appropriate and careful use of supplies and equipment. * Utilizes appropriate body mechanics to aid in the prevention of muscle strain/injury. Santa Fe Public Schools does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, sexual orientation, gender identity or expression, marital status, pregnancy, disability, age, veteran status, medical/genetic information, or any other characteristic protected by law.
    $15k yearly 22d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare 4.4company rating

    Adjudicator job in Cleveland, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-38.4 hourly 16d ago
  • 2025-2026 SY: Hearing Officer- Long Term Suspension (0.2 FTE)

    Santa Fe Public Schools 4.5company rating

    Remote adjudicator job

    Part-Time Employment Title: Hearing Officer - Long Term Suspension Work Unit: Family and Community Engagement Reports To: Chief Family and Community Engagement Officer Contract Length: 10 months Pay Schedule: Principal/Assistant Principal Overtime Status: Exempt Hours: Variable Union Status: NEA Licensure: Pre K-12 Administrative Note: All positions with Santa Fe Public Schools require a post-offer/pre-employment background check. Some positions have additional requirements as established by federal or state rules and regulations. General Function: The Long-Term Suspension Hearing Officer serves as an impartial adjudicator for student discipline cases that may result in a long-term suspension or expulsion. The position ensures hearings are conducted in alignment with federal and state law, district policy, and due process requirements. The Hearing Officer reviews evidence, hears testimony from all parties, and issues written findings and recommendations to the Superintendent or designee. Education/Training/Experience: Minimum: Master's Degree or National Board Certification and NMPED Level 3B Administrator's License Preferred: Bilingual: English-Spanish Knowledge/Skills and Abilities: Strong understanding of New Mexico Public Education Department regulations and SFPS policies related to student discipline. Ability to maintain impartiality, confidentiality, and professionalism in sensitive situations. Exceptional oral and written communication skills. Proficiency in Microsoft Office and Google Suite. Strong organizational skills and attention to detail. Ability to manage multiple cases simultaneously under tight timelines. Conflict resolution, negotiation, and mediation skills. Experience as a principal or assistant principal related to student discipline at the school site. Essential Job Functions: Performs all functions in accordance with established policies, procedures, safety and environmental regulations, and facility and computer security protocols. Duties are subject to change as needed to meet organizational needs. Current essential responsibilities include, but are not limited to, the following: Serve as the impartial hearing officer in long-term suspension hearings. Schedule and conduct hearings in compliance with legal and policy timelines. Review and evaluate evidence, witness statements, and relevant documentation. Ensure that all parties understand hearing procedures and their rights. Facilitate testimony from students, parents/guardians, school staff, and other witnesses. Maintain an accurate and complete record of proceedings. Prepare and issue timely written findings of fact, conclusions, and recommendations. Collaborate with district administrators and legal counsel as appropriate. Maintain confidentiality of all student and case information. Stay current on applicable laws, regulations, and best practices in student discipline. Salary Range and Benefits: $15,000+ (At 0.2 FTE) Resources Used in Performing Job Include (but are not limited to): Standard office equipment and software platforms such as Microsoft Office (Word, Excel, PowerPoint) and the Google Suite. Telephone, fax, copier, computer, stamp machine, badge machine, calculator. Physical/Cognitive Requirements: Regularly required to stand and move throughout a room and/or facility. Communicates verbally and electronically. Uses hands to handle or feel objects, tools, or controls and reach with hands and arms. Frequently required to stoop, kneel, crouch, and/or crawl. Occasionally required to sit, climb, balance, and drive. May have occasion to perform heavy lifting up to 40 pounds. Specific vision abilities required include close vision, distance vision, color vision, and the ability to adjust focus. Must possess and maintain a valid driver's license and private automobile. Some evening or weekend work and travel may be required. Environmental Conditions: Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT) and extensive personal computer and phone usage. Work from home may be required. Some sitting, standing, bending and reaching may be required. Some occasional travel is required for meetings and conferences. Personal Accountability: Demonstrates reliability as evidenced by attendance records and punctuality. Properly notifies supervisor and/or designee of absences or tardiness. Begins and completes work within the allotted time. Consistently appears in attire appropriate to the work environment. Demonstrates skill in the use of equipment including its capabilities, limitations and appropriate/ special application. Protects the district's resources through appropriate and careful use of supplies and equipment. Utilizes appropriate body mechanics to aid in the prevention of muscle strain/injury. Santa Fe Public Schools does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, sexual orientation, gender identity or expression, marital status, pregnancy, disability, age, veteran status, medical/genetic information, or any other characteristic protected by law.
    $15k yearly 25d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare Inc. 4.4company rating

    Adjudicator job in Cincinnati, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $21.7-38.4 hourly 17d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare Inc. 4.4company rating

    Adjudicator job in Akron, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $21.7-38.4 hourly 17d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare 4.4company rating

    Adjudicator job in Akron, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-38.4 hourly 16d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare 4.4company rating

    Adjudicator job in Cincinnati, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-38.4 hourly 16d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare Inc. 4.4company rating

    Adjudicator job in Dayton, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $21.7-38.4 hourly 17d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare 4.4company rating

    Adjudicator job in Dayton, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-38.4 hourly 16d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare Inc. 4.4company rating

    Adjudicator job in Ohio

    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 proficiency. 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: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $21.7-38.4 hourly 17d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare 4.4company rating

    Adjudicator job in Ohio

    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 proficiency. 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: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-38.4 hourly 16d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare Inc. 4.4company rating

    Adjudicator job in Columbus, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $21.7-38.4 hourly 17d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare 4.4company rating

    Adjudicator job in Columbus, OH

    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 proficiency. 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: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-38.4 hourly 16d ago

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