Claims Examiner

Job description

·  Job Description:

DXC Technology (NYSE: DXC) is the world’s leading independent, end-to-end IT services company, helping clients harness the power of innovation to thrive on change. Created by the merger of CSC and the Enterprise Services business of Hewlett Packard Enterprise, DXC Technology serves nearly 6,000 private and public sector clients across 70 countries. The company’s technology independence, global talent and extensive partner alliance combine to deliver powerful next-generation IT services and solutions. DXC Technology is recognized among the best corporate citizens globally. For more information, visit http://www.dxc.technology/ .  

         

Responsible for timely resolution of complex claims and adjudication, as well as claims research when necessary.   Also responsible for timely and accurate processing of all claims adjustments via the Reversal/Replacement process.

·  Follows adjudication policies and procedures to ensure proper payment of claims.
·  Resolves pending claims based on Medicaid rules and regulation established for final processing.
·  Resolves claims resolution and/or adjustments/voids.
·  Processes claim adjustments through Reversal/Replacement requests submitted by providers.
·  Prices claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.
·  Meets established production requirements consistently.
·  Maintains an accuracy rate of 98% or better.
·  Processes financial transactions.
·  Data entry Medicaid claims
·  Prep and data enter all  LTC transactions.
·  Contributes a positive attitude to the team in order to meet department goals.
·  Supports all departmental initiatives in improving overall efficiency

Qualifications

·  Basic knowledge of Microsoft Office Outlook, Word and Excel
·  General knowledge of PC
·  Good working knowledge of the 10 key bad as well as the main keyboard
·  Good, basic Mathematical skills a plus
·  Good verbal and written communication skills
·  High School Diploma or equivalent GED
·  Ability to abide by Molina’s policies
·  Maintain regular attendance based on agreed-upon schedule
·  Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
·  Ability to establish and maintain positive and effective working relationships with coworkers, clients, members, providers and customers