Claim processor jobs in Idaho Falls, ID

Company Profile "Enhancing the Lives of Those We Touch by Helping People Reach Their Goals” Melaleuca has firmly supported this mission statement since our humble beginning in 1985. Everything we accomplish is done with an eye toward promoting the physical, environmental, financial, and personal wellness of those around us. Our focus has always been on wellness. By manufacturing and selling effective, high quality, natural, health oriented products we help people live more vibrant, healthier, and happier lives. When you walk through the doors at Melaleuca, you can feel it immediately. This is The Wellness Company. We have achieved consistent and profitable growth with our annual revenue consistently hitting over $2 billion dollars. Recognized as one of America's Most Trusted Brands and one of the nation's Best Stores, the Melaleuca name represents a promise we uphold every day-delivering a world-class customer experience in everything we do. With a global team of over 4,000 employees and operations in 19 countries, Melaleuca is positioned to grow even more rapidly in upcoming years. Overview Weighs out and processes bulk product in accordance with all applicable SOPs, regulations and procedures Great Starting Pay $18.00 +$1.00 Shift Differential Longevity Bonus (5 Yrs/$5000, 10 Yrs/$10,000, 15 Yrs/$15,000, etc.) Company Profit Sharing (After 6 Mo of F/T Employment) First Pay Review After 6 Months Free Company Products (Monthly voucher currently equal to $100/month value - $1200/year) Company Sponsored Employee Appreciation Events Healthy Work Life Balance Clean Indoor Climate Controlled Environment Opportunities to Promote No Layoffs Safe/All Natural Product Line Responsibilities Essential Responsible for following all Plant Policies, Safety Policies, Procedures and Regulations (including but not limited to FDA, FSMA, HACCP, GMP, OSHA, Lock Out Tag Out, Required PPE) Excellent Technological Skills to use the copier, handheld scanner and navigate such programs as Microsoft Excel, Word, email, JDE, RFGen and MasterControl Excellent communication skills including being able to read and follow instructions and to write detailed explanations of work performed. Also able to communicate professionally between Supervisors, shifts and departments any process changes or delays Responsible for sanitation using compressed air, hot water, cleaning and sanitizing chemicals, and vacuums to maintain a clean and safe environment for the consumer and the plant Actively participate in meetings, safety programs, personal development, and company improvements Responsible for driving a forklift safely and under control in tight spaces and in high traffic areas Ability to work well under pressure and multi-task as the demand necessitates Expected high personal and team performance with an ability to work without direct supervision Excellent eye for detail to create a batch from raw ingredients to its final blended stage Ability to determine changes in ingredient color/consistency Clean up and dispose of expired ingredients, returned bulks and other materials in accordance with Federal, State, and Local regulations Train/supervise new employees to share vital information/skills to improve their job performance Take responsibility for inventory control Performs other duties in the facility as needed or assigned Qualifications Essential Ability to learn and drive a standup forklift and a scissor lift safely Ability to work in and around high places Ability to weigh ingredients to nearest 1/1000 th of a pound Must be able to work with allergens (Milk, Soy and Shellfish) Must be able to read and follow directions as given without deviating from the process Good written and verbal communication skills Good math skills (add, subtract, multiply and divide) Must be able to problem solve and work under pressure Ability to work independently, efficiently and accurately with limited supervision Ability to lift a minimum of 60 lbs on a regular basis Must work in tight spaces including under and around processing equipment Must be able to work in varying working conditions including hot, humid and dusty environments Must be willing to learn, remember and follow all Plant Policies, Safety Policies, Procedures and Regulations (including but not limited to FDA, FSMA, HACCP, GMP, OSHA, Lock Out Tag Out, Required PPE) One year or more experience in manufacturing environment or equivalent is preferred One year or more experience driving a forklift safely is preferred Willing to work overtime and on weekends as needed Good mechanical understanding to be able to disassemble and reassemble processing equipment Ability to learn and use an overhead crane safely Why Melaleuca Melaleuca is one of the leading Health and Wellness companies in the world. We manufacture and distribute nutritional, pharmaceutical, personal care, facial care, home hygiene, and other wellness products and distribute them directly to the consumer through a full-service catalog and Internet shopping system. We carefully craft products used every day with the highest standards of safety, health, and wellness in mind. This revolutionary system is changing the way hundreds of thousands of people shop by eliminating middlemen and reducing marketing and distribution costs. This enables the company to spend more on research and high-quality, ecologically-sensible ingredients, while maintaining reasonable prices. Great culture - flexibility is a must in this position; you'll become a part of a fast-paced team dedicated to a feel-good lifestyle brand dedicated to changing lives. Like the rest of Melaleuca, we are proud to be part of a values-driven organization that treats employees with respect. Our employees and their families enjoy company parties and countless discounts around the community. We implement a very real open-door policy, and all employees are on a first name basis-it feels more like a family than a multi-national corporation. Safe, uncrowded, affordable - nestled in the heart of beautiful Eastern Idaho, Idaho Falls is a prosperous and vibrant community, as well as the gateway to recreational paradise. This unique setting provides numerous opportunities for total wellness -- social, physical, financial, and emotional. If you love outdoor activities, this is the place for you, with the Snake River running right through town, the Rocky Mountains dominating the horizon, and Yellowstone less than a 2-hour drive away. Excellent compensation - in addition to a competitive wage, we offer comprehensive benefits for our full-time employees that include all you would expect plus some remarkable surprises, such as a longevity bonus. The next step is yours. To apply today, click on the "Apply" button below.

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking an experienced and motivated Claims Investigator professional to join our Special Investigation unit. The position requires the following, but is not limited to: * Become familiar with the specialized investigation of claims * Meet with people involved with claims. This may be outside our office environment. * Increased role as a trainer/resource for branch associates in the Claims Department. * Develop and present educational materials to claim associates that focus on fraud awareness/investigation. Desired Skills & Experience * Bachelor's degree or equivalent experience. * Ability to handle conflict comfortably. * Field Claim Rep with Auto and Field experience preferred. * Ability to read, interpret and react to documents such as insurance policies, procedures manuals, and legal documents. * Able to assemble information, develop opinions and clearly express decisions using sound reasoning and judgment. * Ability to write reports and compose correspondence. * Ability to communicate, both verbally and in writing, and possess good problem resolution skills and good interpersonal skills. * Able to accurately deal with mathematics and financial areas and develop an understanding of personal and business finance documents. * Can tactfully and effectively deal with all types of people. * Able to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage. * Ability to organize assigned work. * Ability to maintain a professional image. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. * Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-AT1 #LI-Hybrid

Job Description Claim Specialist Location: Buhl, ID Please note: This job requires working on-site; remote work is not available Type: Hourly The Claim Specialist manages insurance claims from first notice of loss through settlement, ensuring accuracy and compliance with company procedures. This role requires strong communication skills, attention to detail, and the ability to advocate for clients throughout the claims process. Key Responsibilities: Handle claim service calls and emails promptly Manage Personal and Commercial Lines claims from start to finish Review policies for coverage and prepare claim forms Communicate with adjusters and underwriters for clarification Act as a trusted advisor and advocate for clients Document all activities in Applied Epic Maintain organized workflows and email management Attend carrier meetings and trainings Requirements: High School Diploma/GED Idaho Property/Casualty License 1+ years insurance experience (agency preferred) Proficient in Microsoft Office; Applied Epic a plus Strong customer service, organizational, and communication skills Work Environment: Office-based role with regular phone, email, and virtual meetings; occasional in-person client or carrier interactions. Why Join Us? Be part of a supportive, team-oriented environment that values professional growth Gain hands-on experience with both Personal and Commercial Lines claims Access ongoing training and development opportunities Work with a company that prioritizes client advocacy and integrity Enjoy a structured workflow and modern technology tools to make your job easier

WE ARE HIRING! Join our team as a Hazard Claims Representative dedicated to providing exceptional support to our borrowers. In this role, you will be the primary point of contact for customers in regard to their insurance claims. You will answer questions regarding claims, start the claims process for borrowers, and complete claims processing per Agency requirements. In This Role, You Will: Initiate the claims process for borrowers and ensure all necessary documentation is collected and inspections have been ordered Provide clear information and answer questions about claims procedures Collect paperwork and order inspections for claims Process customer requests related to insurance claims efficiently and accurately Enter, track, and update claims information in accordance with agency requirements Monitor claims progress and follow up to ensure timely completion Answer incoming phone calls from borrowers regarding their insurance claims Collaborate with internal teams to resolve any issues or discrepancies related to claims Other duties as assigned Why Work With Us? At our organization, we are dedicated to improving lives and strengthening Idaho communities. We believe that housing opportunities, self-sufficiency, and economic development are the pillars of progress. Our commitment to our team is unwavering, and we consider our employees our greatest priority. Join us and be part of a professional and mission-driven organization that makes a meaningful impact on the lives of Idahoans. Requirements 6+ months of experience in residential real estate lending, residential loan processing, loan closing, and/or loan servicing preferred Strong customer service orientation and interpersonal skills Excellent verbal and written communication skills Ability to work independently, organize, prioritize, perform job responsibilities Ability to be flexible, engaged, reliable and respectful to maintain excellent team relations Attention to detail and accuracy in data entry and documentation High school diploma or equivalent Salary Description $18.00

Job Description Job Type: Contract Workplace Type: Hybrid (50% remote, 50% fieldwork) Compensation: $20/hr plus $.50/mi Phoenix Loss Control (PLC) is a US-based business services provider in the cable, telecom, and utilities sector. PLC's core service is outside plant damage investigation, recovery, and prevention. Across the US and parts of Canada, we help our clients recover the costs of third-party damage to their infrastructure, such as underground fiber optic or gas lines. PLC currently employs over 140 people, servicing some of the largest cable and telecoms operators (e.g., Comcast, Spectrum, AT&T, and Google). PLC is currently aggressively expanding its business and looking for talented and energetic people to bring onboard to help drive growth. POSITION SUMMARY Outside Plant Damage (OPD) costs our clients over 30 million annually. Field investigators are needed to collect, access, and report these damages. This is a part-time, on-call contract job to help support our clients with damage recovery. For our field investigators, each day and every investigation is different. We need inquisitive, self-driven individuals who are comfortable rolling up their sleeves and working in a constantly changing, dynamic environment. Duties Conduct on-site field investigations Write detailed but concise investigation reports using diverse sources of information, types of evidence, witness statements, and costing estimates Develop and maintain comprehensive knowledge of local and state statutes, laws, and regulations for underground and aerial cables and utility service lines Remain prepared and willing to respond to damage calls within a timely manner Complete damage investigations within 7 days and then work with and support our claims managers to complete the investigation and begin the recovery process Respond to damages same day if received during business hours (if not, first response following day) Accurately record all time, mileage, and other associated specific items Requirements Interpersonal skills to gather information and conduct field interviews with involved parties including contractors and technicians, witnesses, law enforcement, and possible damagers Smartphone to gather photos, videos, and other information while conducting investigations Computer, with high-speed internet access, to upload and download reports, research cases, and to interact with our claims system and other databases and portals Exceptional attention to detail and strong written and verbal communication skills Proven ability to operate independently and prioritize while adhering to timelines Strong and objective analytical skills Valid driver's license, current insurance, and reliable vehicle with ability to respond to damages at any time Safety vest, work boots, and hard-hat Preferred Qualifications and Skills Current or previous telecommunication or utility experience Knowledge of underground utility locating procedures and systems Investigation, inspection, or claims/field adjusting Criminal justice, legal, or military training or work experience Engineering, infrastructure construction, or maintenance background Remote location determined at discretion of investigations manager This is a contract position. There are no benefits offered with this position.

Join Our Campus Community! Thank you for your interest in joining the University of Wyoming. Our community thrives on the contributions of talented and driven individuals who share in our mission, vision, and values. If your expertise and experience align with the goals of our institution, we would be thrilled to hear from you. We encourage you to apply and become a valued member of our vibrant campus community today! Why Choose Us? At the University of Wyoming, we value our employees and invest in their success. Our comprehensive benefits package is designed to support your health, financial security, and work-life balance. Benefits include: Generous Retirement Contributions: The State contributes 14.94% of your gross salary, and you contribute 3.68%, totaling 18.62% toward your retirement plan. Exceptional Health & Prescription Coverage: Enjoy access to medical, dental, and vision insurance with competitive employer contributions, that include 4 deductible options to suit your needs. Paid Time Off: Benefit from ample vacation, sick leave, paid holidays, and paid winter closure. Tuition Waiver: Employees and eligible dependents can take advantage of tuition waivers, supporting continuous education and professional growth. Wellness and Employee Assistance Programs: Stay healthy with wellness initiatives, counseling services, and mental health resources. At the University of Wyoming, we are committed to creating a supportive and enriching workplace. To learn more about what we offer, please refer to UW's Benefits Summary. JOB TITLE: Admissions Processor - Admissions JOB PURPOSE: Under limited supervision, process all applications, transcripts, test scores and correspondence for new, re-enrolling, transfer, outreach and international student applications for undergraduate and graduate admissions to the University of Wyoming. ESSENTIAL DUTIES AND RESPONSIBILITIES: Process and load all applications for admission using computers and software in area; review and update student information as new documents arrive. Load application fee. Evaluate and recalculate GPA for most transcripts, and all international students. Determine the eligibility of students for admission and load as appropriate. Provide customer service to students and parents. Maintain accurate records to assure that complete official academic records are on file. Train and assist new employees, including student workers. Double-check for accuracy and assist with necessary clean-up reports. Meet with campus departments as necessary to evaluate and develop new processes when needed and serve as a resource. Provide backup and assist with scanning, indexing, front-desk coverage, and big mailings and data entry. SUPPLEMENTAL FUNCTIONS: May assist with large mailings. May help with check-in during Saturday events. Other duties as assigned. COMPETENCIES: Attention to Detail Judgment Independence Quality Orientation Service Orientation Work Tempo MINIMUM QUALIFICATIONS: Education: Associate's degree or an equivalent combination of education and work experience Experience: 2 years progressively responsible work-related experience DESIRED QUALIFICATIONS: Strong attention to detail and organizational skills Ability to work independently on routine and complex tasks Experience processing large volumes of data with a high degree of accuracy Interest in data accuracy, systems management, and procedural improvement REQUIRED APPLICATION MATERIALS: Complete the online application. The department additionally requests candidates upload the following document(s) for a complete application: Cover letter Resume or C.V. Contact information for four work-related references (references will only be contacted if you are selected as a finalist for the position). This job will remain open until filled. Early application is encouraged as priority consideration will be given to candidates that apply prior to December 7th, 2025. **Due to a current system limitation, you may only be prompted to upload your resume/CV and a Cover Letter. To ensure your application is complete, we recommend you put all of your application materials into one file with your cover letter. However, if you're experiencing any issues in doing so, please send any additional application materials to ****************, and a recruiter will manually add them to your application packet. To help us process your application more efficiently, please include the 6-digit job ID number (located at the bottom of the job posting) in your email. WORK LOCATION: On-campus: This position provides vital support to campus customers, and the successful candidate must be available to work on campus. WORK AUTHORIZATION REQUIREMENTS: The successful candidate must be eligible to work in the United States. Sponsorship for H-1B work authorization or work visa is not available for this position. HIRING STATEMENT/EEO: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. In compliance with the ADA Amendments Act (ADAAA), if you have a disability and would like to request an accommodation to apply for a position, please contact us at ************ or email ****************. ABOUT LARAMIE: The University of Wyoming is located in Laramie, a charming town of 30,000 residents nestled in the heart of the Rocky Mountain West. The state of Wyoming continues to invest in its only 4-year university, helping to make it a leader in academics, research, and outreach with state-of-the-art facilities and strong community ties. We invite you to learn more about Laramie by visiting the About Laramie website. Located in a high mountain valley near the Colorado border, Laramie offers both outstanding recreational opportunities and close proximity to Colorado's Front Range and the metropolitan Denver area. Laramie's beautiful mountain landscape offers outdoor enjoyment in all seasons, with over 300 days of sunshine annually. For more information about the region, please visit ************************

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. 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: $21.16 - $46.42 / 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.

Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNI #IN-DNI

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: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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: $21.16 - $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.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. Knowledge/Skills/Abilities * Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. * This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. * Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. * Assists in the reviews of state or federal complaints related to claims. * Supports the other team members with several internal departments to determine appropriate resolution of issues. * Researches tracers, adjustments, and re-submissions of claims. * Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. * Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. * Handles special projects as assigned. * Other duties as assigned. Knowledgeable in systems utilized: * QNXT * Pega * Verint * Kronos * Microsoft Teams * Video Conferencing * Others as required by line of business or state Job Function Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. Job Qualifications REQUIRED EDUCATION: Associate's Degree or equivalent combination of education and experience; REQUIRED EXPERIENCE: 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry PREFERRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: 4 years PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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. Pay Range: $21.16 - $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.

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: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. Knowledge/Skills/Abilities * Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. * This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. * Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. * Assists in the reviews of state or federal complaints related to claims. * Supports the other team members with several internal departments to determine appropriate resolution of issues. * Researches tracers, adjustments, and re-submissions of claims. * Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. * Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. * Handles special projects as assigned. * Other duties as assigned. Knowledgeable in systems utilized: * QNXT * Pega * Verint * Kronos * Microsoft Teams * Video Conferencing * Others as required by line of business or state Job Function Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. Job Qualifications REQUIRED EDUCATION: Associate's Degree or equivalent combination of education and experience; REQUIRED EXPERIENCE: 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry PREFERRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: 4 years PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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. Pay Range: $21.16 - $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.

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: $21.16 - $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.

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: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.