Remote Lead Analyst — Regulatory Configuration & Claims

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

Job summary

Molina Healthcare is seeking a regulatory configuration professional to translate complex coverage and claims requirements into actionable system parameters. You will work with stakeholders to document, validate, and implement configuration changes across states and products.

The role emphasizes monitoring regulatory updates, coordinating reviews with health plans, and delivering concise reports on status, trends, and financial impact in a remote, multi-time-zone environment.

Qualifications

• Five+ years in system management, data maintenance, or analytics in managed care.
• Experience with claims processing systems and regulatory interpretation.
• Proficient in Microsoft Office, including advanced Excel techniques like PivotTables.

Responsibilities

• Interprets regulatory, contractual, and business requirements into configuration parameters.
• Develops documentation for coverage, reimbursement, and claims processing configurations.
• Monitors regulatory updates and assesses impact on products and payments.
• Leads cross-functional projects across states and products with limited direction.
• Creates reporting tools and status updates for configuration initiatives.

Skills

System management

Data maintenance

Analytical skills

Communication

Excel skills

QNXT familiarity

Tools

QNXT

Networx Pricer

Job description

Molina Healthcare is seeking a regulatory configuration professional to translate complex coverage and claims requirements into actionable system parameters. You will work with stakeholders to document, validate, and implement configuration changes across states and products.

The role emphasizes monitoring regulatory updates, coordinating reviews with health plans, and delivering concise reports on status, trends, and financial impact in a remote, multi-time-zone environment.