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Analyst, Business

Long Beach, California Job ID 1903742
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Job Description

Job Summary:
Our ideal candidate will have previous experience as a Business Analyst and or Claims Examiner working in a managed care organization.  In this role you will focus on claims analysis to determine the root cause of why a claim is paid incorrectly, duplicated, overpaid, etc. You will analyze complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in data sets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements.  Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

• Provides analytical, problem solving foundation including: definition and documentation, specifications.  
•Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.
• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.
• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met
• Prepares high level user documentation and training materials as needed.


Job Qualifications

Required Education:
Associate's Degree or equivalent combination of education and experience

Required Experience:
• 3-5 years of business analysis.
• 2-3 years managed care experience (e.g. Claims).
• Ability to create Excel spreadsheets.
• Claims Analysis experience to determine root cause analysis (e.g. why a claim is paid incorrectly, why there's duplicate claims, why we are overpaying the claim, etc...).
• Ability to understand our systems in order to follow a claim through the entire process to see what's going on with claim to come up with a hypothesis.
• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education:
Bachelor's Degree or equivalent combination of education and experience

Preferred Experience:
• 1-3 years formal training in Business Analysis and/or Systems Analysis
• Knowledge of Molina Systems (e.g. QNXT, Claims Viewer, etc...).

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.


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