Analyst, Business

Molina Healthcare; United States; On-site; USD 75,000 - 110,000; Full time

Job summary

Molina Healthcare is seeking a regulatory and requirements analyst to interpret coverage and reimbursement needs, align changes to regulatory baselines, and support governance with stakeholders. You will manage cross-functional coordination, monitor updates, and drive process improvements in a remote team environment.

The role emphasizes analytical problem solving, clear communication, and the ability to work independently across time zones while building training materials and supporting

Qualifications

• At least 2 years of experience in managed care, health insurance, or related field.
• Strong analytical and problem-solving skills.
• Proficient with Office products (Word, Excel, Outlook, Teams).

Responsibilities

• Develops and maintains requirement documents related to coverage, reimbursement and system changes to align with regulatory baseline requirements.
• Monitors sources to ensure updates are aligned.
• Leads coordinated development and review processes with key partner organizations.
• Conducts analysis to identify root causes and assist with problem management.
• Communicates interpretations and changes to health plans/product teams for alignment and traceability.
• Self-organized reporting to keep leadership informed of impact on finances.
• Engages with operations leadership and Plan Support functions on compliance-based issues.
• Builds VILT sessions in the LMS.
• Supports intake triage, scheduling logistics, and report reconciliation.
• Identifies and applies automation/AI tools to improve processes and workflows.

Skills

Analytical skills

Problem solving

Communication skills

Time management

Tools

Office Suite

Job description

JOB DESCRIPTION

Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable.

JOB SUMMARY

JOB DUTIES

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements.
• Monitors sources to ensure all updates are aligned.
• Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations.
• Conducts analysis to identify root cause and assist with problem management.
• Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices.
• Self-organized reporting to ensure leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials.
• Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.
• Builds Virtual Instructor-Led Training (VILT) sessions in the Learning Management System (LMS).
• Supports intake triage, scheduling logistics, and report reconciliation activities.
• Identifies and applies automation and AI tools to improve processes, streamline workflows, and increase efficiency in training operations and related support activities.

KNOWLEDGE/SKILLS/ABILITIES

• Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning.
• Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
• Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company.
• Ability to concisely synthesize large and complex requirements.
• Ability to organize and maintain regulatory data including real-time policy changes.
• Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems.
• Ability to work independently in a remote environment.
• Ability to work with those in other time zones than your own.

JOB QUALIFICATIONS

Required Qualifications

• At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.
• Strong analytical and problem-solving skills.
• Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
• Previous success in a dynamic and autonomous work environment.

Preferred Qualifications

• Project implementation experience
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services(CMS) and the Affordable Care Act (ACA).
• Medical Coding certification.

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