Analyst, Claims Research

Molina Healthcare • Cedar Rapids, IA • 4h ago

JOB DESCRIPTION Job Summary

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.

Essential Job Duties

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.

Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.

Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.

Assists with reducing rework by identifying and remediating claims processing issues.

Locates and interprets claims-related regulatory and contractual requirements.

Tailors existing reports and/or available data to meet the needs of claims projects.

Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.

Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.

Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.

Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.

Works collaboratively with internal/external stakeholders to define claims requirements.

Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.

Fields claims questions from the operations team.

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.

Appropriately conveys claims-related information and tailors communication based on targeted audiences.

Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.

Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.

Supports claims department initiatives to improve overall claims function efficiency.

Required Qualifications

At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.

Medical claims processing experience across multiple states, markets, and claim @types.

Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.

Data research and analysis skills.

Organizational skills and attention to detail.

Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.

Ability to work cross-collaboratively in a highly matrixed organization.

Customer service skills.

Effective verbal and written communication skills.

Microsoft Office suite (including Excel), and applicable software programs proficiency.

Preferred Qualifications

Health care claims analysis experience.

Project management experience.

QNXT, Salesforce and basic SQL

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $21.65 - $46.42 / HOURLY

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

Similar Jobs

Analyst, Claims Research

Molina Healthcare • Iowa City, IA • 12h ago

Finance, Accounting & Banking

JOB DESCRIPTION Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of proces...

12h ago

Go to Apply

Mortgage Processor 1

Hills Bank • Coralville, IA • 1d ago

Finance, Accounting & Banking

1009 2nd Street, Coralville, IA, USA | Full Time SCHEDULE: Full-time; Monday through Friday (8:00 am - 5:00 pm). Average of 40 hours/week with overtime during the busy times. LOCATION: 1009 2nd St, Coralville, IA 52241 B...

1d ago

Go to Apply

Accounting Clerk

Robert Half • Cedar Rapids, IA • 3d ago

Finance, Accounting & Banking

Description Join Robert Half, the world's first and largest specialized talent solutions and business consulting firm, as a Tax Preparer for this tax season. We are seeking a skilled and detail-oriented professional to a...

3d ago

Go to Apply

Operations Accounting Manager

Danaher Corporation • Coralville, IA • 5d ago

Finance, Accounting & Banking

Bring more to life. Are you ready to accelerate your potential and make a real difference within life sciences, diagnostics and biotechnology? At Integrated DNA Technologies (IDT), one of Danaher's ( https://danaher.com/...

5d ago

Go to Apply

VP/Director of Finance

Robert Half • Cedar Rapids, IA • 1w ago

Finance, Accounting & Banking

Description We are looking for an accomplished finance leader to join our team. This is a long-term contract position ideal for a detail-oriented individual with a strong background in financial management, team leadersh...

1w ago

Go to Apply

Private Banking Associate

University of Iowa Community Credit Union • North Liberty, IA • 1w ago

Finance, Accounting & Banking insurance

Position Summary POSITION SUMMARY: The Private Banking Associate creates, collects, analyzes, exercises judgment and advises members on Private Banking products and services. This position is responsible for maintaining...

1w ago

Go to Apply

Part-time Teller

Hills Bank • North Liberty, IA • 1w ago

Finance, Accounting & Banking

25 Hwy 965 NE, North Liberty, IA, USA | Hourly | 17.00 per hour | Part Time The starting wage for this position is $17.00/hr. with a comprehensive and competitive benefits package This position is eligible for a Spanish...

1w ago

Go to Apply

Mortgage Lender

Hills Bank • Iowa City, IA • 2w ago

Finance, Accounting & Banking

1401 South Gilbert Street, Iowa City, IA, USA | Full Time SCHEDULE: Full-time ; Monday through Friday (8:30 am - 5:30 pm) Evenings and Weekends by appointment. Average of 40 hours a week. LOCATION: 1401 S Gilbert St, Iow...

2w ago

Go to Apply

Accountant

Robert Half • Cedar Rapids, IA • 2w ago

Finance, Accounting & Banking

Description Seeking a new opportunity as an Accountant? Check out this opportunity! Location: Cedar Rapids, Iowa Duration: Contract / Short-Term Assignment Join a dynamic team and make an immediate impact! Our client is...

2w ago

Go to Apply

Tax Manager

Aston Carter • Coralville, IA • 2w ago

Finance, Accounting & Banking

Hiring! Tax Manager Opening in the Coralville Area! Apply Now!! Job Description The Tax Manager will play a key leadership role in managing client relationships, overseeing tax compliance, and supporting internal staff....

2w ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.