Molina Healthcare · 2 months ago
Senior Specialist, Premium Reconciliation & Billing (Must Reside in WI)
Wisconsin, United States
Full-time
Onsite
Mid, Senior Level
$14.90/hr - $29.06/hr
3+ years expMolina Healthcare is seeking a Senior Specialist in Premium Reconciliation & Billing to support the reconciliation of premiums for members enrolled through the Healthcare Marketplace. The role involves processing invoices, reconciling payments, and guiding member service representatives to resolve inquiries related to healthcare premiums.
Health CareHospitalMedical
Responsibilities
Process daily enrollee's (Individual and family) invoices and premium reconciliation for Marketplace members
Reconcile premiums received from the individual subscriber or responsible party with the amount due for the healthcare program the member is enrolled
Guide and support Member Service representatives to help them resolve member inquiries related to healthcare premium
Assist in resolution for escalated premium issues with Appeals and Grievances team members
Guide and collaborates with enrollment team to resolve eligibility issues affecting premium billing
Generate billing data using the QNXT premium billing module to be sent to print and fulfillment vendor
Reconcile unallocated payments on a daily basis
Resolve orphan member payments on a daily basis
Reconcile monies received from the financial institution
Perform month-end invoicing and accuracy audits
Comply with all State/Regulatory requirements
Under limited supervision, drives and supports reconciliation of premiums for members enrolled though the Healthcare Marketplace as a part of the Affordable Care Act (ACA)
Reconciliation will be performed for more complex premiums received from members, state agencies and CMS
Team member will work closely with enrollment teams and offer guidance where premiums are directly impacted by enrollment discrepancies
Collaborate with and advises call center teams to maintain member satisfaction for this product
Work with financial institutions to ensure timely and accurate processing of payment received
Qualification
Required
Process daily enrollee's (Individual and family) invoices and premium reconciliation for Marketplace members
Reconcile premiums received from the individual subscriber or responsible party with the amount due for the healthcare program the member is enrolled
Guide and support Member Service representatives to help them resolve member inquiries related to healthcare premium
Assist in resolution for escalated premium issues with Appeals and Grievances team members
Guide and collaborates with enrollment team to resolve eligibility issues affecting premium billing
Generate billing data using the QNXT premium billing module to be sent to print and fulfillment vendor
Reconcile unallocated payments on a daily basis
Resolve orphan member payments on a daily basis
Reconcile monies received from the financial institution
Perform month-end invoicing and accuracy audits
Comply with all State/Regulatory requirements
Marketplace, Commercial, or Medicare healthcare experience with premium billing and reconciliation
Must have excellent time management and organizational skills
Strong team-oriented individual
Excellent communication with all levels of team
Must have strong knowledge and experience in MS office products, minimally Outlook, Word and Excel
Access or SQL experience is a plus
Excellent verbal and written communication skills
Ability to abide by Molina's policies
Maintain regular attendance based on agreed-upon schedule
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
High School diploma required
3+ years of Member Billing /R
Marketplace, Commercial or Medicare Industry preferred
None
Preferred
Associates Degree or higher preferred
Healthcare industry experience, with emphasis on enrollment, member billing, and premium reconciliation preferred
Benefits
Competitive benefits and compensation package
Company
Molina Healthcare
Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.
10001+ employees
H1B Sponsorship
Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (56)
2024 (45)
2023 (43)
2022 (31)
2021 (35)
2020 (55)
Funding
Current Stage
Public CompanyTotal Funding
$2.35B2025-11-17Post Ipo Debt· $850M
2024-11-13Post Ipo Debt· $750M
2021-11-16Post Ipo Debt· $750M
Leadership Team
Dave Reynolds
Executive Vice President, Health Plans & Medicaid Chief Operating Officer
Debbie Simkins
Vice President, Office of the CIO
Recent News
Sherwood News
2026-01-09
2026-01-03
Company data provided by crunchbase