Claims Auditor

Job Description

JOB DESCRIPTION Job Summary

Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.

Essential Job Duties

• Audits the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing of claims errors.
• Prepares, tracks and provides claims audit findings reports according to established timelines.
• Presents claims audit findings and makes recommendations to leadership for improvements based on audit results.
• Reviews timeliness of claims processing to ensure compliance with contractual and state/federal requirements.
• Maintains minimum claims audit accuracy rate per contractual guidelines.
• Supports claims department initiatives to improve overall claims function efficiency.
• Meets claims audit department quality and production standards.
• Completes basic claims projects as assigned.
• Experience in reviewing high $ claims, claims payment method.

Required Qualifications

• At least 2 years of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience.
• Audit, research, and data entry 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.

Preferred Qualifications

• Health care claims auditing/billing 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

Job Info

Job Identification: 2034966

Job Category: Operations

Posting Date: 2025-12-02T18:47:29 00:00

Job Schedule: Full time