Lead Analyst, Configuration Oversight - Coordination of Benefits/SQL - Remote

Molina Healthcare; Long Beach (CA); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider in California is seeking a Claims Operations Analyst. In this role, you'll review Medicaid COB claims, analyze payment discrepancies, and contribute to a collaborative team environment. Ideal candidates will have significant experience in claims and auditing within healthcare, along with proficiency in QNXT and Microsoft Office. Competitive benefits and opportunities for career growth are provided.

Benefits

Career advancement opportunities

Competitive benefits package

Collaborative work environment

Qualifications

• Minimum of 5 years of experience in oversight, auditing, and government regulations.
• Strong understanding of QNXT claims processes.
• Effective verbal and written communication skills.

Responsibilities

• Review Medicaid COB claims for regulatory compliance.
• Analyze trends or discrepancies related to payments.
• Provide training to junior analysts.

Skills

Claims analysis

Communication skills

Regulatory compliance

Proficiency in Microsoft Office

Education

Associates Degree or equivalent

Bachelor’s Degree (preferred)

Tools

QNXT

SQL

Job description

Overview

Employer Industry: Healthcare Services

Why consider this job opportunity

• Opportunity for career advancement and growth within the organization
• Competitive benefits and compensation package offered
• Supportive and collaborative work environment
• Chance to make a significant impact on payment integrity and claims operations
• Involvement in meaningful work that aligns with regulatory compliance and healthcare standards

What to Expect (Job Responsibilities)

• Review Medicaid Coordination of Benefits (COB) claims for accurate secondary pricing logic and compliance with regulations
• Analyze claim outcomes, identifying trends or discrepancies related to payments
• Utilize QNXT for claims history research, provider contract setup, and benefits configuration
• Collaborate cross-functionally with various teams to resolve identified issues
• Act as a subject matter expert in Medicaid COB claim adjudication and provide training to junior analysts

What is Required (Qualifications)

• Associates Degree or equivalent combination of education and experience
• 5+ years of experience in oversight, auditing, and government regulations/compliance
• Strong understanding of QNXT claims processes and ability to troubleshoot discrepancies
• Proficient in Microsoft Office applications, including Excel, Word, and PowerPoint
• Effective written and verbal communication skills

How to Stand Out (Preferred Qualifications)

• Bachelor’s Degree or equivalent experience
• Prior experience in Payment Integrity and/or COB/Claims roles at a health plan or vendor
• Familiarity with claim recovery audits and Medicaid regulatory reporting requirements
• Exposure to EDI transactions (837, 835) and COB data exchange protocols
• Experience with SQL

#HealthcareServices #ClaimsOperations #PaymentIntegrity #CareerOpportunity #RegulatoryCompliance

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