Job Description

Job Summary

Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.

Knowledge/Skills/Abilities



Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.

Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.

Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.

Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.

Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.

Coordinate, facilitate and document audit walkthroughs.

Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.

Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..

Ability to write SQL queries

Experience with QNXT configuration

Experience with troubleshooting and analyzing issues.

Experience working in a Medicare environment is highly preferred.

Claims adjudication experience is highly preferred.



Job Qualifications

Required Education

Associate's Degree or two years of equivalent experience

Required Experience

Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: Analytical experience within managed care operations. Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.

Preferred Education

Bachelor's Degree

Preferred Experience

Six years proven analytical experience within an operations or process-focused environment. Previous audit and/or oversight experience.

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 - $116,835 / ANNUAL

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