Lead Configuration Oversight Analyst - Claims Audit

Molina Healthcare; United States; On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare seeks a lead analyst for configuration oversight and claims auditing. You will oversee end-to-end audits, validate data across provider databases, and ensure compliance with contracting, network management, credentialing, and related requirements.

Your role includes leading peer reviews, developing BRDs/FRDs, and driving cross-functional solutions across the software lifecycle to support accurate claims processing.

Qualifications

• At least 5 years of claims auditing experience in a health care operations setting.
• Expert understanding of claims processes and auditing.
• Experience in SQL, PowerBI, MS Access, PowerQuery.
• Expert at identifying and troubleshooting claim discrepancies via contracts, regulations and resources.
• Strong analytical and communication skills.
• Advanced MS Office, including Excel (VLOOKUP, Pivot).

Responsibilities

• Interpret end-to-end business requirements and ensure outcomes meet state/federal requirements.
• Create reporting tools to communicate audit results on configuration accuracy.
• Write complex ad-hoc reports related to configuration/claims.
• Validate accuracy of complex scripts and configuration update processes.
• Lead peer review processes and associate reviews.
• Validate new configuration processes/solutions for accuracy.
• Verify MRDT, fee schedules, premiums and related file loads.
• Communicate audit findings in meetings and written formats.

Skills

Analytical thinking

Communication

Attention to detail

Problem solving

Tools

SQL

PowerBI

MS Access

PowerQuery

Job description

Molina Healthcare seeks a lead analyst for configuration oversight and claims auditing. You will oversee end-to-end audits, validate data across provider databases, and ensure compliance with contracting, network management, credentialing, and related requirements.

Your role includes leading peer reviews, developing BRDs/FRDs, and driving cross-functional solutions across the software lifecycle to support accurate claims processing.