Lead, Medicare Appeals & Grievances (PST Hours)

Molina Healthcare, Inc.; Long Beach (CA); Remote; USD 73,000 - 112,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a Senior Claims Supervisor to lead a team responsible for member and provider appeals, grievances, and related resolutions. You will ensure compliance with CMS and Molina guidelines while driving process improvements across the department.

Responsibilities include supervising appeals workflows, auditing processes, and coordinating with member services and corporate counterparts. Strong leadership, communication, and regulatory knowledge are essential.

Qualifications

• Strong verbal and written communication skills required.
• Experience leading projects and teams in a claims environment.
• Deep knowledge of managed care, Medicaid/Medicare guidelines and denials processing.
• Proficiency with Microsoft Office suite and data tracking.
• Ability to audit processes and drive regulatory-compliant resolutions.

Responsibilities

• Supervise team handling member and provider appeals and grievances.
• Ensure timely and compliant resolutions per CMS and Molina guidelines.
• Audit and improve business processes for grievances resolution.
• Prepare narratives, graphs, and reports for committees and audits.
• Maintain call tracking and documentation to meet regulatory timelines.
• Oversee claims production standards and performance metrics.

Skills

Verbal & written communication

Leadership/management experience

Managed care / claims processing

Regulatory awareness (CMS/Medicaid/Med

Project leadership

Tools

Microsoft Office

Job description

Molina Healthcare, Inc. is seeking a Senior Claims Supervisor to lead a team responsible for member and provider appeals, grievances, and related resolutions. You will ensure compliance with CMS and Molina guidelines while driving process improvements across the department.

Responsibilities include supervising appeals workflows, auditing processes, and coordinating with member services and corporate counterparts. Strong leadership, communication, and regulatory knowledge are essential.