• Associate Analyst, Claims Research

    Molina Healthcare (Rochester, NY)


    Job Description

    Job Summary

    Provides entry level analyst support for claims research activities. This role plays a pivotal role in ensuring the timely and accurate resolution of provider-submitted claims issues. This role requires a keen understanding of medical claims processing, strong analytical skills, and the ability to effectively triage issues to the appropriate department for further investigation or correction. This is a production-based role, with clear expectations for meeting production and quality standards.

    Job Duties

    + Reviews and analyzes claims-related issues submitted by providers to identify potential root causes quickly and accurately.

    + Triages issues based on type and complexity, assigning them to the appropriate department or team for further research or correction.

    + Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate assessments.

    + Meets quality and production goals.

    + Maintains detailed records of claim reviews and resolutions.

    + Identifies trends in submitted issues to inform process improvements and reduce recurring errors.

    + Provides feedback and recommendations for process improvements.

    + Completes training and development activities to stay current with industry standards and best practices.

    Job Qualifications

    REQUIRED QUALIFICATIONS:

    + At least 1 year of experience in claims processing or operations or equivalent combination of relevant education and experience

    + Basic knowledge of medical billing and basic claims processes.

    + Problem-solving skills

    + Verbal and written communication skills and ability to collaborate

    + Ability to work independently and as part of a team

    + Microsoft Office suite/applicable software program(s) proficiency

    PREFERRED QUALIFICATIONS:

    + Experience with process improvement methodologies.

    + Knowledge of industry regulations and compliance standards.

    + Familiarity with systems used to manage claims inquiries and adjustment requests

    + Understanding of billing and coding procedures

    + Experience with Medicaid, Medicare, and Marketplace claims

     

    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: $21.16 - $38.37 / HOURLY

     

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