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 Pay Range: $18.35 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.