Analyst, Business - SQL (Remote in Florida)

Molina Healthcare; California, Town of Florida (MO, NY); Remote; USD 49,930 - 97,363; Full time

Benefits offered by this job

Competitive benefits package

Equal Opportunity Employer

Job summary

A leading health insurance provider is seeking a candidate for a role focused on the accurate intake and interpretation of regulatory requirements, supporting systems solutions development. The ideal candidate will have at least 2 years of experience in a managed care organization and strong analytical skills. Responsibilities include developing requirement documents and communicating changes to multiple stakeholders. This position offers competitive compensation and is suitable for independent workers in a remote environment.

Qualifications

• At least 2 years of relevant experience in a managed care organization or health insurance.
• Knowledge of policy/government legislative review.
• Experience in a dynamic and autonomous work environment.

Responsibilities

• Develops and maintains requirement documents.
• Leads coordinated development and ongoing management processes.
• Communicates requirement interpretations and changes to health plans.

Skills

Strong analytical and problem‑solving skills

Strong interpersonal and communication skills

Ability to organize and maintain regulatory data

Ability to work independently in a remote environment

Education

2 years experience in a managed care organization or health insurance

Relevant education or equivalent experience

Tools

Office Product Suite (Word, Excel, Outlook, Teams)

Basic SQL

Job description

JOB DESCRIPTION

Job Summary

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 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 as it relates to state requirements.
• 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.
• Provides support for requirement interpretation inconsistencies and complaints.
• Self-organized reporting to ensure health plans/product team and other 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.

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.
• Policy/government legislative review knowledge.
• 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

• Basic SQL knowledge is preferred.
• 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.

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: $49,930 - $97,363 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.