Associate Analyst, Claims Research (Remote)-Triage

Molina Healthcare; Northern (KY); Remote; USD 20,000 - 44,000; Full time

Benefits offered by this job

Competitive benefits

Employee wellness program

Job summary

Molina Healthcare in the United States is seeking an entry-level Claims Analyst to support claims research activities. You will review provider-submitted questions, triage issues for investigation, and apply knowledge of claims processing to deliver timely resolutions.

This role emphasizes accuracy, documentation, and collaboration within a cross-functional team to meet production and quality standards, identify trends, and contribute to process improvements in a highly matrixed environment.

Qualifications

• Experience in medical claims processing or healthcare operations.
• Strong data research and analysis capabilities.
• Excellent organization and ability to manage multiple tasks.

Responsibilities

• Review claims-related issues submitted by providers to identify root causes.
• Triage issues by type and complexity for appropriate research or correction.
• Apply knowledge of claims processing workflows and regulations to assess claims.
• Meet quality and production goals and maintain detailed records.
• Identify trends to inform process improvements and reduce errors.
• Provide feedback for process improvements in provider claims research.

Skills

Claims data analysis

Attention to detail

Time management

Customer service

Problem solving

Independent & team work

Verbal & written communication

Excel

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

Provides entry level analyst support for claims research activities. Ensures timely and accurate resolution of provider submitted claims issues/inquiries. Leverages understanding of medical claims processing and uses analytical skills to effectively triage issues to facilitate claims investigation or correction. Meets established production and quality standard. Identifies trends in claims issues to inform process improvements and drive continuous improvement in claims performance and compliance.

Essential Job Duties

• Reviews and analyzes claims-related issues submitted by providers to identify potential root-cause issues; triages issues quickly and accurately.
• Triages issues based on type and complexity, assigning 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 claims 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 related to provider claims research.

Required Qualifications

• At least 1 year of experience in medical claims processing/research and/or health care operations , or equivalent combination of relevant education and experience.
• Basic medical claims processing knowledge.
• Data research and analysis skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Customer service skills.
• Problem-solving skills.
• Ability to work independently and as part of a team, and collaborate cross-functionally across a highly matrixed organization.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs 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.

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

Pay Range: $14.76 - $31.97 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.