Analyst, Claims Research - Remote

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    "ExternalDescriptionStr": "<p>JOB DESCRIPTION Job Summary</p>\n<p>Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.</p>\n<p>&nbsp;</p>\n<p><strong>Essential Job Duties</strong></p>\n<p>• Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.<br>\n • Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.<br>\n • Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.<br>\n • Assists with reducing rework by identifying and remediating claims processing issues.<br>\n • Locates and interprets claims-related regulatory and contractual requirements.<br>\n • Tailors existing reports and/or available data to meet the needs of claims projects.<br>\n • Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.<br>\n • Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.&nbsp;<br>\n • Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.<br>\n • Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.<br>\n • Works collaboratively with internal/external stakeholders to define claims requirements.&nbsp;<br>\n • Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.<br>\n • Fields claims questions from the operations team.<br>\n • 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.<br>\n • Appropriately conveys claims-related information and tailors communication based on targeted audiences.<br>\n • Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.<br>\n • Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.<br>\n • Supports claims department initiatives to improve overall claims function efficiency.<br>\n &nbsp;</p>\n<p><strong>Required Qualifications</strong></p>\n<p>• At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.<br>\n • Medical claims processing experience across multiple states, markets, and claim types.<br>\n • Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.<br>\n • Data research and analysis skills.<br>\n • Organizational skills and attention to detail.<br>\n • Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.<br>\n • Ability to work cross-collaboratively in a highly matrixed organization.<br>\n • Customer service skills.<br>\n • Effective verbal and written communication skills.<br>\n • Microsoft Office suite (including Excel), and applicable software programs proficiency.<br>\n &nbsp;</p>\n<p><strong>Preferred Qualifications</strong></p>\n<p>• Health care claims analysis experience.<br>\n • Project management experience.<br>\n &nbsp;</p>\n<p>#PJClaims</p>\n<p>#LI-AC1</p>\n<p>&nbsp;</p>\n<p>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.<br><br>\n Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p>",
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