Senior Analyst, Claims Research

divh2Senior Claims Research Analyst / h2pThe Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. / ppJob Duties : / pulliUses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects / liliAssists with reducing re-work by identifying and remediating claims processing issues / liliLocate and interpret regulatory and contractual requirements / liliExpertly tailors existing reports or available data to meet the needs of the claims project / liliEvaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error / liliAct as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements / liliLeads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits / liliConducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions / liliInterprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes / liliDevelops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time / liliProvides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format / liliTakes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach / liliProactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency / liliCollaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals / li / ulpJob Qualifications : / ppRequired Qualifications : / pulli5+ years of experience in medical claims processing, research, or a related field / liliDemonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management / liliAdvanced knowledge of medical billing codes and claims adjudication processes / liliStrong analytical, organizational, and problem-solving skills / liliProficiency in claims management systems and data analysis tools / liliExcellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers / liliProven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment / liliMicrosoft office suite / applicable software program(s) proficiency / li / ulpPreferred Qualifications : / pulliBachelors Degree or equivalent combination of education and experience / liliProject management / liliExpert in Excel and PowerPoint / liliFamiliarity with systems used to manage claims inquiries and adjustment requests / li / ulpTo all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board. / ppMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $80,168 - $106,214 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level. / p / div