Lead Analyst, Claims/ Regulatory Compliance - Marketplace
Molina Healthcare Covington, Kentucky; Phoenix, Arizona; Santa Fe, New Mexico; Syracuse, New York; Detroit, Michigan; Austin, Texas; Owensboro, Kentucky; West Valley City, Utah; Lincoln, Nebraska; Tacoma, Washington; Akron, Ohio; Idaho; Utah; San Antonio, Texas; Cleveland, Ohio; Orlando, Florida; Vancouver, Washington; Las Cruces, New Mexico; Cincinnati, Ohio; Bellevue, Washington; Bellevue, Nebraska; Caldwell, Idaho; Dallas, Texas; Kearney, Nebraska; Rochester, New York; Atlanta, Georgia; Savannah, Georgia; Green Bay, Wisconsin; Nampa, Idaho; Davenport, Iowa; Kentucky; Iowa; Michigan; Madison, Wisconsin; Mesa, Arizona; Kenosha, Wisconsin; Grand Island, Nebraska; Layton, Utah; Texas; New Mexico; Ohio; Nebraska; Orem, Utah; Lexington-Fayette, Kentucky; Boise, Idaho; Spokane, Washington; Grand Rapids, Michigan; Buffalo, New York; Salt Lake City, Utah; Idaho Falls, Idaho; Albany, New York; Meridian, Idaho; Warren, Michigan; Louisville, Kentucky; Rio Rancho, New Mexico; Des Moines, Iowa; Miami, Florida; Omaha, Nebraska; Ann Arbor, Michigan; Houston, Texas; Provo, Utah; Columbus, Ohio; Augusta, Georgia; Sioux City, Iowa; Dayton, Ohio; Georgia; New York; Florida; Washington; Scottsdale, Arizona; Tampa, Florida; Macon, Georgia; Milwaukee, Wisconsin; Sterling Heights, Michigan; Columbus, Georgia; St. Petersburg, Florida; Racine, Wisconsin; Iowa City, Iowa; Jacksonville, Florida; Wisconsin; Bowling Green, Kentucky; Albuquerque, New Mexico; Yonkers, New York; Everett, Washington; Chandler, Arizona; Fort Worth, Texas; Tucson, Arizona; Roswell, New Mexico; Cedar Rapids, Iowa Job ID 2032154JOB DESCRIPTION
Job Summary
Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
KNOWLEDGE/SKILLS/ABILITIES
- Trains staff on configuration functionality, enhancements, and updates.
- Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.
- Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.
- Creates management reporting tools to enhance communication on configurations updates and initiatives.
- Negotiates expected completion dates with Health Plans.
- Extensive experience on researching, presenting and documenting is required,
- Experience with Medicare, Medicaid and Marketplace is required.
- Medical coding experience is highly preferred.Â
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
7-9 years
Preferred Education
Graduate Degree or equivalent 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: $77,969 - $155,508 / 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: 06/16/2025ABOUT OUR LOCATION
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