Job Description

Provides lead level support for core operations activities including claims processing, benefit interpretation, provider services, provider enrollment, etc., ensuring functional operations and contractual compliance.

Essential Job Duties

• Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.

• Performs daily troubleshooting procedures to support enrollment, disenrollment, claims, and claims support functions as needed.

• Coordinates workflow and staffing of day-to-day activities, and assigns and monitors work of staff to adhere to productivity and quality standards.

• Participates in or leads quality improvement efforts to improve claims processes and/or policies.

• Serves as operations subject matter expert, provides training, mentoring and support to team personnel.

Job Requirements

• At least 4 years of health care operations/claims/provider services experience, or equivalent combination of relevant education and experience.

• Customer service experience.

• Knowledge of Medicare, Medicaid, and Marketplace plans.

• Experience supporting a Medicaid or large claims processing environment with multi-functional work units and tasks.

• Organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.

• Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.

• Effective verbal and written communication skills.

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

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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