Job Details

divh2Job Summary/h2pProvides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution./ppstrongEssential Job Duties/strong/pulliServes as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects./liliInterprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams./liliManages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests./liliAssists with reducing rework by identifying and remediating claims processing issues./liliLocates and interprets claims-related regulatory and contractual requirements./liliTailors existing reports and/or available data to meet the needs of claims projects./liliEvaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors./liliApplies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes./liliSeeks to improve overall claims performance, and ensure claims are processed accurately and timely./liliIdentifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance./liliWorks collaboratively with internal/external stakeholders to define claims requirements./liliRecommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing./liliFields claims questions from the operations team./liliInterprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims./liliAppropriately conveys claims-related information and tailors communication based on targeted audiences./liliProvides sufficient claims information to internal operations teams that communicate externally with providers and/or members./liliCollaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance./liliSupports claims department initiatives to improve overall claims function efficiency./li/ulpstrongRequired Qualifications/strong/pulliAt least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience./liliMedical claims processing experience across multiple states, markets, and claim types./liliKnowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs./liliData research and analysis skills./liliOrganizational skills and attention to detail./liliTime-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines./liliAbility to work cross-collaboratively in a highly matrixed organization./liliCustomer service skills./liliEffective verbal and written communication skills./liliMicrosoft Office suite (including Excel), and applicable software programs proficiency./li/ulpstrongPreferred Qualifications/strong/pulliHealth care claims analysis experience./liliProject management experience./li/ulpTo all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board./ppMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level./p/div