65 applicantsPosted by Agency

Company

Molina Healthcare · 3 hours ago

Analyst, Claims Research

Arizona, United States

Full-time

Remote

Mid, Senior Level

$20.29/hr - $46.42/hr

5+ years exp

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Responsibilities

Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects

Assists with reducing re-work by identifying and remediating claims processing issues

Locate and interpret regulatory and contractual requirements

Tailors existing reports or available data to meet the needs of the claims project

Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing errors

Applies claims processing and technical knowledge to appropriately define a path for short/long term systematic or operational fixes

Helps to improve overall claims performance to ensure claims are processed accurately and timely

Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance

Works closely with external departments to define claims requirements

Recommends updates to Claims SOP’s and Job Aid’s to increase the quality and efficiency of claims processing

Fields claims questions from Molina Operations teams

Interprets, 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

Provides excellent customer services to our internal operations teams concerning claims projects

Appropriately convey information and tailor communication based on the targeted audience

Provides sufficient claims information to our internal operations teams that must communicate externally to provider or members

Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance

Manages work assignments and prioritization appropriately

Other duties as assigned.

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.

Claims analysisMedical claims processingExcelProject managementPowerPoint

Required

Associate’s degree or equivalent combination of education and experience

1-3 years claims analysis experience

5+ years medical claims processing experience across multiple states, markets, and claim types

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

Knowledge and experience using Excel

Preferred

Bachelor's Degree or equivalent combination of education and experience

1-3 years claims analysis

6+ years medical claims processing experience

Project management

Expert in Excel and PowerPoint

Benefits

Competitive benefits and compensation package

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

10,001+ employees

https://careers.molinahealthcare.com

H1B Sponsorship

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Trends of Total Sponsorships

2023 (33)

2022 (36)

2021 (33)

2020 (60)