Sr Claims Systems Data Analyst - QNXT
Molina Healthcare Everett, Washington; Albany, New York; Nebraska; Idaho; New York; Santa Fe, New Mexico; Kearney, Nebraska; Grand Island, Nebraska; Bellevue, Washington; Seattle, Washington; Houston, Texas; New Mexico; Washington; Austin, Texas; Orem, Utah; St. Petersburg, Florida; Idaho Falls, Idaho; Provo, Utah; Green Bay, Wisconsin; Iowa; Kenosha, Wisconsin; Chandler, Arizona; Texas; Sioux City, Iowa; Cedar Rapids, Iowa; Davenport, Iowa; Jacksonville, Florida; Detroit, Michigan; Syracuse, New York; Yonkers, New York; New York, New York; Bowling Green, Kentucky; Atlanta, Georgia; Racine, Wisconsin; Madison, Wisconsin; Milwaukee, Wisconsin; Dallas, Texas; West Valley City, Utah; Layton, Utah; Dayton, Ohio; Akron, Ohio; Cleveland, Ohio; Sterling Heights, Michigan; Mesa, Arizona; Orlando, Florida; Rochester, New York; Caldwell, Idaho; Bellevue, Nebraska; Omaha, Nebraska; Ann Arbor, Michigan; Tampa, Florida; Buffalo, New York; Owensboro, Kentucky; Columbus, Georgia; Michigan; Boise, Idaho; Long Barn, California; Ohio; Meridian, Idaho; Las Cruces, New Mexico; Grand Rapids, Michigan; Lincoln, Nebraska; Des Moines, Iowa; Cincinnati, Ohio; Tacoma, Washington; Rio Rancho, New Mexico; Lexington-Fayette, Kentucky; Utah; Augusta, Georgia; Nampa, Idaho; Florida; Tucson, Arizona; Phoenix, Arizona; San Antonio, Texas; Albuquerque, New Mexico; Roswell, New Mexico; Salt Lake City, Utah; Columbus, Ohio; Warren, Michigan; Fort Worth, Texas; Savannah, Georgia; Georgia; Wisconsin; Iowa City, Iowa; Scottsdale, Arizona; Vancouver, Washington; Spokane, Washington; Miami, Florida; Covington, Kentucky; Louisville, Kentucky; Kentucky; Macon, Georgia Job ID 2031419JOB DESCRIPTION
Job Summary
Responsible for accurate and timely review of production support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains understanding of solution functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Â Validates data received on claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to identify defects in the solution or configuration during warranty period.Â
KNOWLEDGE/SKILLS/ABILITIES
- Knowledge of healthcare claims and claim processing from receipt through encounter submission
- Strong Knowledge in QNXT required
- Knowledge of Edifecs strongly preferred
- Strong SQL knowledge required
- Ability to write complex queries for impact analysis
- Writes complex ad-hoc reports
- Understanding of Healthcare EDI Claims transactions preferred
- Understanding of complex claim payment methodologiesÂ
- Understanding of configuration solutions preferred
- Ability to use critical thinking to analyze claim processing issues Â
- Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.
- Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment
- Participates in defect resolution for assigned component
- Participates in the implementation and conversion of new and existing health plans.
- Manage projects from requirements to deployment, including work assignment, prioritization, issue triage etc.
- Complex projects with some mentoring
- Moderate to Simple projects without mentoring
- Researches issues and sets up proof of concept tests.
JOB QUALIFICATIONS
Required Education
Associate degree or equivalent combination of education and experience
Required Experience
3-4 Years
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
5-6 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: 05/16/2025ABOUT OUR LOCATION
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