AVP, Core Operations (Claims)
Molina Healthcare Arizona; Kenosha, Wisconsin; Columbus, Georgia; Caldwell, Idaho; Des Moines, Iowa; Kentucky; Louisville, Kentucky; Cedar Rapids, Iowa; Detroit, Michigan; Roswell, New Mexico; Cleveland, Ohio; Austin, Texas; Salt Lake City, Utah; Provo, Utah; Milwaukee, Wisconsin; Madison, Wisconsin; Bowling Green, Kentucky; Ohio; Bellevue, Nebraska; Kearney, Nebraska; Rochester, New York; Tucson, Arizona; Macon, Georgia; Nampa, Idaho; Michigan; Utah; Owensboro, Kentucky; Grand Island, Nebraska; Buffalo, New York; Syracuse, New York; Columbus, Ohio; Phoenix, Arizona; Mesa, Arizona; Scottsdale, Arizona; Miami, Florida; Savannah, Georgia; Boise, Idaho; Idaho; Texas; Warren, Michigan; Ann Arbor, Michigan; Wisconsin; Lincoln, Nebraska; Rio Rancho, New Mexico; New York, New York; Houston, Texas; Fort Worth, Texas; Spokane, Washington; Chandler, Arizona; Atlanta, Georgia; Augusta, Georgia; Florida; Georgia; Lexington-Fayette, Kentucky; Covington, Kentucky; Sterling Heights, Michigan; Yonkers, New York; Dayton, Ohio; Layton, Utah; Bellevue, Washington; Jacksonville, Florida; Tampa, Florida; Meridian, Idaho; Idaho Falls, Idaho; Nebraska; New Mexico; New York; Washington; Santa Fe, New Mexico; Akron, Ohio; San Antonio, Texas; West Valley City, Utah; Tacoma, Washington; Orlando, Florida; Iowa; Davenport, Iowa; Albuquerque, New Mexico; Cincinnati, Ohio; Dallas, Texas; Orem, Utah; Vancouver, Washington; Green Bay, Wisconsin; Racine, Wisconsin; St. Petersburg, Florida; Sioux City, Iowa; Iowa City, Iowa; Grand Rapids, Michigan; Omaha, Nebraska; Las Cruces, New Mexico Job ID 2030244JOB DESCRIPTION
Job Summary
Responsible for planning, developing, and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve
KNOWLEDGE/SKILLS/ABILITIES
- Implements companywide initiatives relevant to Claims Production, i.e., Claims Production, Audit, Production Vendor Oversight.
- Leads activities supporting the production of claims including but not limited to the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, Corporate Encounter Team as well as providing overall organizational leadership of claims editing and recovery vendors aimed at managing overall healthcare costs.
- Engages with IT and other departments to implement changes to business processes and systems for Corporate Operations PMO
- Implements Corporate Configuration of the QNXT system as well as the Care Management application for UM functions within QNXT and enables system to produce expected costs.
- Ensures state regulatory requirements are met, maximizes MASS Adjudication within QNXT, improves process quality, reduces G&A costs, and continues to drive positive operational and financial outcomes within all initiatives.
JOB QUALIFICATIONS
Required Education
Graduate Degree or equivalent combination of education and experience
Required Experience
7-9 years
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
10+ years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $140,795 - $274,550 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 02/07/2025ABOUT OUR LOCATION
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