Sr Analyst, Claims Research; Medicaid Claims) Remote

United States

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Molina Healthcare is hiring for Senior Analyst, Claims Research. This position is fully remote.
Highly Qualified Candidates Will Have the Following Experience –

• Experience with medical claims, specifically Medicaid claims
• Advanced Excel user
• QNXT / QNXT Claims (preferred, not required)
• Ability to perform root-cause analysis, and resolve issues through system corrections, manual adjustments, or provider education to support claim accuracy
• Strong communication skills, both written and verbal
• Provides senior level analyst support for claims research activities. Ensures timely and accurate resolution of provider submitted claims issues/inquiries. Leverages deep understanding of medical claims processing, analytical skills, root-cause analysis, and regulatory interpretation to effectively triage issues to facilitate complex/high-priority claims investigation or correction. Develops remediation strategies, ensures timely and accurate claims project execution, and drives continuous improvement in claims performance and compliance.
• Leverages claims subject matter expertise and advanced analytical skills to conduct research and analysis for provider claims issues, requests, and inquiries, and provide recommendation for remediation and resolution.
• Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing errors.
• Advises on complex claims issues and ensures compliance with regulatory and contractual requirements.
• Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
• Assists with reducing re-work by identifying and remediating claims processing issues.
• Conducts root-cause analysis to identify and resolve systemic claims processing errors.
• Locates and interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes.
• Expertly tailors existing reports or available data to meet the needs of the claims research issue/project.
• Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational claims fixes.
• Leads and manages complex claims research projects initiated through provider inquiries, complaints, internal audits, or legal requests.
• Develops, tracks, and/or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time.
• Provides in-depth analysis and insights to leadership and operational teams; presents findings, progress updates, and results in a clear and actionable format.
• Takes lead in provider update meetings; clearly communicates findings, proposed solutions, and status updates.
• Fields claims questions from the operations team.
• Appropriately conveys claims-related information and tailors communication based on targeted audiences
• Proactively identifies and recommends updates to policies, standard operating procedures (SOPs), and job aids to improve claims quality and efficiency.
• Collaborates with internal/external departments and leadership to define claims requirements and ensure alignment with organizational goals.
• Collaborates with multiple departments to define and implement long-term solutions related to claims issues and efficiencies.
• Collaborates with cross-functional teams on claims-related projects; completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
• Provides training, mentoring and support to new and existing claims research team members.

Required Qualifications

• At least 3 years of experience in…