JOB DESCRIPTION

Job Summary

Support the Nebraska Health plan SLT by providing subject matter expertise on complex claims related issues and service recovery efforts. 

Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements.  Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

Elicit requirements using interviews, document analysis, and requirements workshops, business process descriptions, use cases, business analysis, task and workflow analysis.Interpret customer business needs and translate them into application and operational requirementsCommunicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as needed.Work with operational leaders within the business to provide recommendations on opportunities for process improvements, medical cost savings or revenue enhancements.Create Business Requirements Documents, Test Plans, Requirements Traceability Matrix, User Training materials and other related documentations.Actively participates in all stages of project and program oversight development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements. Provide Level II claims support to internal teams and directly with providers as neededMonitor and resolve HP work queues related to timely and accurately claims payments and encounters processing.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years of business analysis experience with an emphasis in claims payment accuracy and claims service recovery resolutions6+ years managed care experience (preferably in Payer Claims environment) Demonstrates proficiency in a variety of concepts, practices, and procedures applicable to job-related subject areas to include Provider Data, Claims Configuration, Claims Adjudication and Encounters.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years of troubleshooting claims related escalations Past direct provider interaction experienceExperience working with complex, often highly technical teamsMedicaid primary and Medicare preferable payer claims experience QNXT experience Coding experience SQL experience Salesforce experience

Preferred License, Certification, Association

Certified Business Analysis Professional (CBAP)                                                                                                                                   

Certified Professional Coder (CPC) certification

State Specific Requirements:

Experience navigating Nebraska state and Medicare regulations related to claims configuration and payment accuracy. 

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: $52,176 - $107,098.87 / 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: 06/27/2025