Remote Medicaid Claims Research Lead

Molina Healthcare, Inc.; Oregon; Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare, Inc. is seeking a Senior Analyst, Claims Research. This fully remote role focuses on advanced analysis of Medicaid claims and provider disputes, with strong Excel and QNXT proficiency.

You will conduct root-cause analysis, develop remediation strategies, and collaborate across departments to ensure accurate adjudication and compliance, guiding complex investigations and provider communications.

Qualifications

• At least 3 years in medical claims processing/research
• Advanced Medicaid/Medicare/Marketplace claims knowledge
• Advanced proficiency with claims management systems
• Excellent written and verbal communication
• Ability to work independently in a matrixed organization
• Experience with process improvement methodologies
• Strong data research and analysis skills

Responsibilities

• Provide senior level claims research support and triage complex issues.
• Develop remediation strategies and drive timely project execution.
• Analyze provider claims issues and recommend remediation.
• Ensure regulatory and contractual compliance in adjudication.
• Communicate findings and status to leadership clearly.
• Lead provider update meetings and training for the team.

Skills

Medical claims experience

Provider disputes

Root-cause analysis

Regulatory interpretation

Communication skills

Cross-functional collaboration

Time management

Data analysis

Process improvement

Project management

Tools

QNXT

Excel

Job description

Molina Healthcare, Inc. is seeking a Senior Analyst, Claims Research. This fully remote role focuses on advanced analysis of Medicaid claims and provider disputes, with strong Excel and QNXT proficiency.

You will conduct root-cause analysis, develop remediation strategies, and collaborate across departments to ensure accurate adjudication and compliance, guiding complex investigations and provider communications.