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Molina Healthcare · FL, United States

# Senior Examiner, Claims(Florida)

FL, United States Full-time Senior individual contributor Operations 

Listed on Molina Healthcare’s official careers site. Posted October 15, 2026. Check that it is still open and apply there.
[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039833)

[OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Senior Examiner, Claims(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
- 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.
- Manages a caseload of claims - procures all medical records and statements that support the claim.
- 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.
- Identifies and recommends solutions for error issues as it relates to pre-payment of claims.
- Monitors the medical treatment of claimants; keeps meticulous notes and records for each claim.
- Manages a caseload of various types of complex claims - procures all medical records and statements that support the claim.
- Meets state and federal regulatory compliance regulations on turnaround times and claims payment for multiple lines of business (LOBs).
- Meets department quality and production standards.
- Supports all claims department initiatives to improve overall efficiency.
- Completes claims projects as assigned.

### Required Qualifications
- At least 2 years of experience in claims, and/or customer service experience in a clerical role - 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.
- Customer service experience.
- Effective verbal and written communication skills.
- Microsoft Office suite and applicable software programs proficiency.

### Preferred Qualifications
- Health care claims/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

## At a glance
- Posted by the employer: Oct 15, 2026
- First seen by OpenNash: Oct 18, 2026
- Last checked: Oct 18, 2026
- Listed for: 3 days
- Location: FL, United States
- Employment type: Full-time[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039833)

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