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 - $110,000 / 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
View Map- UM LVN Delegation Oversight Nurse Remote based in CA (CA License) San Francisco California, San Diego California, Los Angeles California, Sacramento California, San Jose California 06/09/2025
- Strategy Advancement Director (Market Development / Medicaid) - REMOTE Yonkers New York, Provo Utah, Kentucky, Nebraska, Lincoln Nebraska, Dayton Ohio, Salt Lake City Utah, Sterling Heights Michigan, Dallas Texas, Orem Utah, Mesa Arizona, Louisville Kentucky, Columbus Georgia, Rochester New York, Scottsdale Arizona, Everett Washington, Owensboro Kentucky, Boise Idaho, Caldwell Idaho, Florida, Atlanta Georgia, Lexington-Fayette Kentucky, Tampa Florida, Phoenix Arizona, Fort Worth Texas, Kearney Nebraska, Augusta Georgia, Georgia, Ohio, Sioux City Iowa, Tacoma Washington, Green Bay Wisconsin, Las Cruces New Mexico, St. Petersburg Florida, Jacksonville Florida, Miami Florida, Macon Georgia, Vancouver Washington, Idaho, Warren Michigan, Columbus Ohio, Idaho Falls Idaho, Houston Texas, Cleveland Ohio, Kenosha Wisconsin, Bellevue Nebraska, Roswell New Mexico, Iowa, Davenport Iowa, Austin Texas, Orlando Florida, Bellevue Washington, West Valley City Utah, New Mexico, Washington, Covington Kentucky, Grand Rapids Michigan, Racine Wisconsin, Iowa City Iowa, Akron Ohio, Bowling Green Kentucky, Albuquerque New Mexico, Rio Rancho New Mexico, Cedar Rapids Iowa, Des Moines Iowa, Detroit Michigan, Savannah Georgia, Wisconsin, New York, Utah, Michigan, Buffalo New York, Omaha Nebraska, Ann Arbor Michigan, Layton Utah, San Antonio Texas, Santa Fe New Mexico, Grand Island Nebraska, Milwaukee Wisconsin, Spokane Washington, Albany New York, Texas, Nampa Idaho, Cincinnati Ohio, Meridian Idaho, Chandler Arizona, Syracuse New York, Madison Wisconsin, Tucson Arizona 06/12/2025
- Specialist, Quality Program Management & Performance (Remote in NM) Albuquerque New Mexico, Las Cruces New Mexico, Roswell New Mexico, Santa Fe New Mexico, Rio Rancho New Mexico 07/17/2025
- Clinical/MTM pharmacy Tech (Bilingual in Mandarin/Cantonese Preferred) Remote PST hours West Valley City Utah, Idaho, Racine Wisconsin, Iowa City Iowa, Madison Wisconsin, Grand Rapids Michigan, Sterling Heights Michigan, Kenosha Wisconsin, Rochester New York, Sioux City Iowa, Texas, Savannah Georgia, Nebraska, Omaha Nebraska, Georgia, Jacksonville Florida, Cleveland Ohio, Las Cruces New Mexico, Salt Lake City Utah, Lexington-Fayette Kentucky, Warren Michigan, Layton Utah, Kearney Nebraska, Phoenix Arizona, Detroit Michigan, Santa Fe New Mexico, Dallas Texas, Macon Georgia, Chandler Arizona, Everett Washington, Caldwell Idaho, Iowa, Mesa Arizona, Davenport Iowa, Roswell New Mexico, Dayton Ohio, Albuquerque New Mexico, Buffalo New York, Tampa Florida, Rio Rancho New Mexico, Cedar Rapids Iowa, Provo Utah, Lincoln Nebraska, Boise Idaho, Wisconsin, Ann Arbor Michigan, Akron Ohio, Cincinnati Ohio, Fort Worth Texas, Des Moines Iowa, Vancouver Washington, Covington Kentucky, Kentucky, New York, Miami Florida, Idaho Falls Idaho, Milwaukee Wisconsin, Scottsdale Arizona, Bellevue Washington, Nampa Idaho, Ohio, Utah, Bowling Green Kentucky, Orem Utah, Augusta Georgia, Orlando Florida, Grand Island Nebraska, Houston Texas, Albany New York, Bellevue Nebraska, Washington, San Antonio Texas, Syracuse New York, Louisville Kentucky, Atlanta Georgia, Green Bay Wisconsin, Owensboro Kentucky, New Mexico, Florida, Michigan, St. Petersburg Florida, Meridian Idaho, Columbus Ohio, Columbus Georgia, Tucson Arizona, Yonkers New York, Spokane Washington, Austin Texas, Tacoma Washington 06/04/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs