32 applicantsPosted by Agency

Company

Molina Healthcare · 18 hours ago

Analyst, Business-(Claims)

Arizona, United States

Full-time

Remote

Mid Level

$21.82/hr - $51.06/hr

3+ years exp

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Responsibilities

Analyzes complex claim inquiries and reimbursement issues using data from internal and external sources to expeditiously resolve claim related concerns.

Identifies and interprets trends and patterns in datasets to root cause and resolve outstanding issues.

Creates reports and analysis based on business needs and required or available data elements.

Collaborates with Health Plans to modify or tailor existing claim analysis or reports to meet their specific needs.

May participate in external provider meetings, including presenting analysis results, summarizing conclusions, and recommending a course of action.

Provides research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit configuration, and other claim reimbursement drivers.

Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

Reviews, researches, analyzes and evaluates all data relating to specific area of expertise.

Begins process of becoming subject matter expert.

Conducts claim analysis and uses analytical skills to identify root cause and assist with problem management as it relates to claim processing.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Medical claims processingData analysisMicrosoft ExcelQNXTSalesforceBusiness analysisManaged care experienceProcess improvementProblem management

Required

Associate's Degree or equivalent combination of education and experience

3-5 Years of business analysis

4+ years managed care experience

Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Provides research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit configuration, and other claim reimbursement drivers

Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

Conducts claim analysis and uses analytical skills to identify root cause and assist with problem management as it relates to claim processing

Experience using Microsoft Excel

Preferred

QNXT experience preferred

Salesforce experience preferred

Bachelor's Degree or equivalent combination of education and experience

1-3 years formal training in Business Analysis and/or Systems Analysis

Company

Molina Healthcare

Glassdoor

3.4

Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.

Founded in 1980

Long Beach, California, USA

10001+ employees

https://careers.molinahealthcare.com

H1B Sponsorship

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Trends of Total Sponsorships

2023 (33)

2022 (36)

2021 (33)

2020 (60)