Adjuster, Claims (Puerto Rico)

JOB DESCRIPTION
Job Summary
Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.
KNOWLEDGE/SKILLS/ABILITIES
Researches tracers, adjustments, and re-submissions.
Handles basic projects as assigned.
Assists with defect reduction by identifying and communicating error issues and potential solutions to management.
Helps to improve overall performance accountability (attendance, communication, flexibility, adaptability, interpersonal skills, teamwork and cooperation).
Adjudicates or re-adjudicate claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.
Meets department quality and production standards.
JOB QUALIFICATIONS
Required Education
Associate degree or equivalent combination of education and experience
Required Experience
1-3 Years
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
3-5 years
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.