Claims Research Triage Analyst — Entry Level

Molina Healthcare; United States; Remote; USD 45,000 - 60,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking an entry-level analyst to support claims research activities, ensuring timely resolution of provider-submitted claims issues and conducting data-driven analyses to inform process improvements. The role involves triaging issues, leveraging claims processing knowledge, and maintaining thorough documentation to meet quality standards.

Ideal candidates have 1+ year in medical claims processing or related health care operations, strong data analysis skills, and

Qualifications

• At least 1 year of experience in medical claims processing or health care operations.
• 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.

Responsibilities

• 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.

Skills

Medical claims processing

Data research and analysis

Time management

Customer service

Problem-solving

Cross-functional teamwork

Verbal and written communication

Tools

Excel

Claims management system

Job description

Molina Healthcare is seeking an entry-level analyst to support claims research activities, ensuring timely resolution of provider-submitted claims issues and conducting data-driven analyses to inform process improvements. The role involves triaging issues, leveraging claims processing knowledge, and maintaining thorough documentation to meet quality standards.

Ideal candidates have 1+ year in medical claims processing or related health care operations, strong data analysis skills, and