Leads and manages team responsible for operations activities including claims processing, benefit interpretation, provider services, provider enrollment, etc., ensuring functional operations, contractual compliance, and alignment with member satisfation, retention, quality, and financial goals.
Essential Job Duties
• Oversees performance and financial results of designated operational units.
• Serves as primary point of contact for all matters related to operational units, and achievement of service level agreements (SLAs) and other contractual requirements under assigned areas of supervision.
• Develops budget inputs for areas of responsibility.
• Attends/facilitates meetings as appropriate for day-to-day activities/responsibilities of operational units.
• In conjunction with leadership, establishes performance goals to support overall operational unit objectives.
• Establishes and maintains excellent relationships with internal and external stakeholders.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
Job Requirements
• At least 7 years of health care operations/claims/provider services experience, or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Strong customer service experience.
• Knowledge of Medicare, Medicaid, and Marketplace plans.
• Experience supporting a Medicaid or experience in a large claims processing environment with multi-functional work units and tasks.
• Strong 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 organizationm and establish and maintain effective relationships with internal and external stakeholders.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency (including Excel), and applicable software programs proficiency.
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
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.
Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
