Senior Examiner, Claims (Remote)-Must reside in Florida
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Before you apply
Salary$15 – $29/hr
LocationFL, United States
Work moderemote
Typefull-time
SenioritySenior
Experience2+ yrs
DepartmentOperations
Company size10,000+ people
First seenOct 17, 2026 · 2w ago
Verified live13h ago
At a glanceSummarised by Seekless from the posting.
At least 2 years of experience in claims, preferably in a managed care setting, or equivalent combination of relevant education and experience
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
Effective verbal and written communication skills
Microsoft Office suite and applicable software programs proficiency
Health care claims/billing experience
Medicaid Experience
Skills
Microsoft Office
Benefits
Health insurance
401(k)
Senior Examiner, Claims (Remote)-Must reside in Florida
Job Description
Job Summary
Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors.
Essential Job Duties
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Evaluates the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.
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Manages a caseload of claims - procures all medical records and statements that support the claim.
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Makes recommendations for further investigation and/or resolution of claims.
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Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication, and recommends solutions to resolve issues.
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Identifies and recommends solutions for error issues as it relates to pre-payment of claims.
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Monitors the medical treatment of claimants; keeps meticulous notes and records for each claim.
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Manages a caseload of various types of complex claims - procures all medical records and statements that support the claim.
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Meets state and federal regulatory compliance regulations on turnaround times and claims payment for multiple lines of business (LOBs).
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Meets department quality and production standards.
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Supports all claims department initiatives to improve overall efficiency.
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Completes claims projects as assigned.
Required Qualifications
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At least 2 years of experience in claims, preferably in a managed care setting, or equivalent combination of relevant education and experience.
•
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.
•
Effective verbal and written communication skills.
•
Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
•
Health care claims/billing experience.
•
Medicaid Experience
Additional Information
Hiring process
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Legal
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Job Info
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Job Identification: 2039548
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Job Category: Operations
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Posting Date: 09/29/2026, 07:13 PM
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Job Schedule: Full time
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Locations: FL, United States
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Salary Range: $15.00 - $29.06 Hourly *Actual compensation may vary based on geographic location, work experience, education and/or skill level
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