Molina Healthcare

Molina Healthcare

Senior Examiner, Claims(Florida)

FL, United States · Senior

Sponsorship not specifiedDetected 2 days ago
ComplianceCustomer SupportResearchCommunicationOrganizational SkillsMicrosoft OfficeClaims Management

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odds of building a lasting career here

31Risky
Cap-exempt (no lottery)0
Sponsors this role58
Entry-level history0
PERM / green-card track0
Lottery odds40
Fits your clock70

Thin sponsorship signal and lottery-bound. A low-probability bet with your clock running. Prioritize cap-exempt roles and proven entry-level sponsors first.

Lottery odds assume a STEM candidate.

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Employer immigration record

from this employer's Department of Labor filings

Green-card filing pattern in this occupation

Context, not a finding about this posting: of this employer's 7 green-card filings in this occupation, 100% were for a worker who already held the job.

Green-card follow-through: 40%

Of 5 labor certifications old enough to have been used, 3 expired without the employer filing the next step. Median time from filing to decision: 500 days.100% of their filings were for a worker who already held the job.Only certifications past the 180-day window are counted — recent ones cannot have expired yet.

Files H-1B transfers

2 transfer filings in the last year, covering 2 workers. Median labor-condition decision: 8 days. An employer that already files transfers is one that can take over an existing H-1B.

Sourced from Department of Labor LCA, PERM and prevailing-wage disclosure data. Employer matching is by name, so figures may be split across an employer's legal entities. Absence of a filing means none appears in our copy of the data, not that none exists.

Community outcomes

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About the role

  • 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.
  • Makes recommendations for further investigation and/or resolution of claims.
  • 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.

Responsibilities

  • 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.

Requirements

  • Microsoft Office suite and applicable software programs proficiency.

Nice to have

  • To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Compensation

  • Molina Healthcare offers a competitive benefits and compensation package.

Benefits

  • Manages a caseload of claims - procures all medical records and statements that support the claim.
  • Manages a caseload of various types of complex claims - procures all medical records and statements that support the claim.
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This listing is sourced directly from Molina Healthcare's careers page and normalized into a canonical job model.