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Project Manager (Benefit Interpretation)

Long Beach, California Job ID 2001293
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Job Description

Job Summary
This position is responsible for supporting development, execution and ongoing management of a defined national benefit interpretation governance processes, developing and managing documentation, process workflows and communication for running the ongoing BI process on behalf of the Marketplace line of business

Duties and Responsibilities:

• Supports BI Program Manager, with process flow and documentation development.
• Monitors, logs, and researches member grievances to resolution or determination.
• Creates documents with required coding information in order to accurately adjudicate claims.
• Prepares decks and decision documents for executive steering committee.
• Maintains a dedicated share point site and outlook mailbox (this may need to be done via iServe).
• Facilitates meetings and work groups.
• Manage ad hoc business processes work groups.
• Design document templates for business documents.
• Creates various workflows and standard operation procedures.
• Conducts extensive product research using federal, state, and local references.
• Works closely with the MP product, Ops teams and Healthcare Services / UM leadership & QNXT (MP) Configuration team in supporting BI management and submitting change requests.
• Performs code analysis using claim reports.

Knowledge, Skills and Abilities:
• Strong analytical and problem-solving skills.
• Ability to synthesize data and summarize results.
• Excellent knowledge of MS Excel and PowerPoint.
• Understanding of SharePoint, and document management.
• Excellent verbal and written communication skills.
• Knowledge of benefit interpretation principles and practices.
• Experience or understanding of benefit configuration principles.
• Knowledge / experience with the Affordable Care Act.
• Familiarity with claim administration systems, ostensibly the Trizetto (QNXT) administrative platform. 
• Strong understanding of Health Insurance Benefits and general configuration practices.
• Strong interpersonal and (oral and written) communication skills.
• Self-motivated and to take initiative, identify, communicate and resolve potential problems.
• Ability to work independently.

Qualifications

Job Qualifications

Required Education:
BA/BS or equivalent experience.

Required Experience:
• 3+ years Program/Project Management experience.
• Commercial Benefit Interpretation process experience.
• CPT or DSM coding knowledge and application.

Preferred Experience:
• Benefit implementation and ongoing management of the benefit implementation process.
• Health Insurance Industry Experience.

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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