JOB DESCRIPTION

Job Summary

Responsible for accurate and timely review of production support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains understanding of solution functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution.  Validates data received on claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to identify defects in the solution or configuration during warranty period. 

KNOWLEDGE/SKILLS/ABILITIES

Knowledge of healthcare claims and claim processing from receipt through encounter submissionStrong Knowledge  in QNXT requiredKnowledge of Edifecs strongly preferredStrong SQL knowledge requiredAbility to write complex queries for impact analysisWrites complex ad-hoc reportsUnderstanding of Healthcare EDI Claims transactions preferredUnderstanding of complex claim payment methodologies Understanding of configuration solutions preferredAbility to use critical thinking to analyze claim processing issues  Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.Gains a deep understanding of Molina claims life cycle and all processes that affect claims paymentParticipates in defect resolution for assigned componentParticipates in the implementation and conversion of new and existing health plans.Manage projects from requirements to deployment, including work assignment, prioritization, issue triage etc.Complex projects with some mentoringModerate to Simple projects without mentoringResearches issues and sets up proof of concept tests.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

3-4 Years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5-6 Years

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 05/16/2025