Job Description

Leads a team of Custom Solution Production Support Analysts responsible for ensuring the stability, accuracy, and business performance of custom claims processing solutions. Oversees the review and resolution of production support issues through root cause and impact analysis, validating claims data to identify configuration and system defects that affect claims adjudication and payment outcomes. Develops and implements monitoring and reporting processes to identify trends, mitigate risks, and drive timely resolution of issues. Provides oversight of new implementations and custom solution deployments, ensuring defects are identified, tracked, and resolved during warranty and post-implementation support periods while maintaining high-quality service and operational excellence.

Essential Job Duties

• Manages technical production support configuration resources, and demonstrates accountability for team performance - including meeting or exceeding established performance targets
• Oversee root cause analysis (RCA) for complex production issues reported by Claims, Health Plans, IT, and other stakeholders ensuring issues are investigated using a structured, fact-based approach that identifies the underlying cause rather than focusing solely on immediate symptoms.
• Represents as primary liaison and technical expert with various functional areas/stakeholders (i.e. utilization management, claims, configuration, provider network, health plan leadership, etc.) to handle escalated issues. Facilitate cross-functional meetings and discussions involving complex or high-priority production issues.
• Participates in and contributes to the development of custom solution defect strategies to meet business needs.
• Analyze production issues occurring to determine whether they represent implementation defects, configuration issues, requirements gaps, operational issues, or other root causes.
• Translate technical findings into clear, concise communications appropriate for both technical and business audiences.
• Lead the 30-day warranty review process for newly deployed or implemented custom solutions to validate solution stability, performance, and business outcomes following production deployment.
• Provide leadership with reporting on warranty outcomes, including significant issues, recurring trends, root causes, and opportunities for improvement.
• Plans for daily priorities, and responds to new priorities and opportunities assigned by leadership.
• Establish and maintain processes, standards, and documentation for production support, root cause analysis, impact reporting, issue management, and post-deployment warranty review. Supports review of operational policies, procedures, guidelines, and job aids to ensure compliance with company and government regulations.
• Maintain operational metrics and reporting related to issue volumes, severity, aging, root cause, business impact, and resolution trends.
• Develops and coaches direct production support team - promoting professional growth and development.
• Leads performance improvement activities for the production support function.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of configuration/department-specific goals.

Required Qualifications

• At least 7 years of configuration oversight, claims, auditing, and/or health care operations experience in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Advanced understanding of claims processes.
• Advanced ability to identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources.
• Ability to write complex SQL queries for impact analysis
• Experience with root cause analysis, incident management, problem management, and impact assessment.
• Strong analytical, critical-thinking, and problem-solving skills.
• Ability to lead cross-functional investigations involving both business and technical stakeholders.
• Strong analytical, critical-thinking, and problem-solving skills.
• Strong multitasking ability, and decision-making skills.
• Flexibility to meet changing business requirements, and strong commitment to high-quality/on-time delivery.
• Ability to work cross-collaboratively in a highly matrixed organization.
• High attention to detail.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency.

Preferred Qualifications

• Experience leading analysis and operational teams in a managed care setting.

• Experience collaborating with various levels of leadership in a highly matrixed organization.

• Deep claims processing, configuration and queries experience.

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