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Adjudicator, Provider Claims - Remote (Inbound Provider Calls)

Molina Healthcare

Remote · USJob$14.76–31.97/hrSeen todaySeen in employer's feed today

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At a glance

Compensation
$14.76–31.97/hr
Location
Remote · US
Work Authorization
Not specified

Olive lists jobs from US employers, including remote roles you can work from the United States.

Job overview

The Adjudicator, Provider Claims supports provider claims adjudication by responding to provider inquiries, investigating claim issues, and helping ensure appropriate resolution. The role handles incoming calls, researches and adjudicates claims, collaborates with internal teams, and contributes to quality, production, and efficiency initiatives. The schedule is a closing shift, Monday through Friday, with hours varying by time zone.

Skills & qualifications

RequiredNice to have

Skills

Claims InvestigationClaims ResearchClaims ResolutionReimbursement Methodology AnalysisResearchData AnalysisOrganizationAttention to DetailTime ManagementMultitaskingCustomer ServiceVerbal CommunicationWritten CommunicationMicrosoft OfficeApplicable Software

Qualifications

2+ Years Clerical ExperienceClaims or Customer Service SettingManaged Care Organization ExperienceEquivalent Education and Experience

Full job description

Mon - Fri

Closing shift

12pm -8:30pm EST

11am - 7:30pm CST

10am - 6:30pm MST

9am - 5:30pm PST

Inbound Provider Call

JOB DESCRIPTION Job Summary

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.

Essential Job Duties

  • Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution.

  • Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues.

  • Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.

  • Assists in reviews of state and federal complaints related to claims.

  • Collaborates with other internal departments to determine appropriate resolution of claims issues.

  • Researches claims tracers, adjustments, and resubmissions of claims.

  • Adjudicates or readjudicates high volumes of claims in a timely manner.

  • Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.

  • Meets claims department quality and production standards.

  • Supports claims department initiatives to improve overall claims function efficiency.

  • Completes basic claims projects as assigned.

Required Qualifications

  • At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience.

  • Research and data analysis 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.

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: $14.76 - $31.97 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

How this job compares

Set against the 627 open Claims Specialist jobs on Olive Jobs, counted November 5, 2026.

Pay
  • This posting$14.76–31.97/hr
  • US median$19–41/hr78 hourly ranges

This range's midpoint, $23.37/hr, is 23% below the US median midpoint ($30/hr) — in the lowest quarter of Claims Specialist hourly ranges across the US.

Openings
Olive Jobs lists 627 open Claims Specialist jobs across the US. 20% of them nationwide are listed as remote or flexible.
Hiring the most across the US
Experience
This posting asks for at least 2 years of experience — less than three in four Claims Specialist postings that state a minimum ask for (median 5 years, across 558 postings).
Education
88 of the 627 open Claims Specialist jobs (14%) ask for a bachelor's degree or higher.

Counted across the open, public US postings on Olive Jobs on November 5, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.

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