JOB DESCRIPTION

Job Summary

Analyzes complex  claim inquiries and reimbursement issues.using data from internal and external sources to expeditiously resolve claim related concerns.  Identifies and interprets trends and patterns in datasets to root cause and resolve outstanding issues. Creates reports and analysis based on business needs and required or available data elements.  Collaborates with Health Plans to modify or tailor existing claim analysis or reports to meet their specific needs. May participate in external provider meetings , including presenting 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. Will work cross functionally across multiple business areas. 

KNOWLEDGE/SKILLS/ABILITIES

Provides research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit configuration, and other claim reimbursement drivers  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 claim analysis and uses analytical skills to identify root cause and assist with problem management as it relates to claim processing Experience using Microsoft Excel QNXT experience preferred Salesforce experience preferred 

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

3-5 Years of business analysis 4+ years managed care experience 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

 

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.