Reporting Analyst, SIU-(Remote)

Lensa; Jacksonville (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading career site is seeking a Reporting Analyst for Molina Healthcare. The role involves ensuring accurate reporting of fraud, waste, and abuse (FWA) referrals. The Analyst will create regulatory reports, support audits, and ensure compliance with laws and regulations. Ideal candidates should have healthcare experience and proficiency in Excel.

Benefits

Competitive benefits

Qualifications

• Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields.
• Minimum 1 year in regulatory reporting; 2-4 years working in managed care.

Responsibilities

• Creating regulatory reports specific to the SIU.
• Performing oversight audits and validation activities.
• Managing and producing regulatory reports independently.

Skills

Excel

Healthcare Fraud Shield

Education

Associate Degree

Job description

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

Under the direct supervision of the Manager, the Reporting Analyst, SIU supports a team in the Special Investigation Unit (SIU). The Reporting Analyst will ensure FWA referrals are logged, documented, assigned for investigation, and appropriately reported to state and federal regulators and/or law enforcement as appropriate. They will ensure that relevant information is gathered and reported timely and accurately (monthly, quarterly, annually). The role includes oversight of SIU tracking systems and may involve peer reviews to ensure timely, accurate, and compliant reporting activities, as well as coordination with other departments to address FWA issues.

Job Duties

1. Creating regulatory reports specific to the SIU, including reports on overpayments, tips/leads, investigative activity, and other summaries.
2. Interpreting and analyzing regulatory rules, contracts, and guidance to assess compliance and support audit procedures.
3. Performing oversight audits and validation activities to ensure compliance with laws, regulations, contracts, and policies.
4. Supporting the SIU team in developing the Operational Oversight Program, including report creation, complaint triage, and regulatory compliance demonstration.
5. Managing and producing regulatory reports independently.
6. Supporting external regulatory audits, including risk assessments, sample submissions, and document preparation (e.g., DMHC, CMS audits).
7. Developing and communicating audit scope, objectives, and timelines with stakeholders.
8. Developing trend reports for compliance, performance, and training needs.
9. Ensuring all regulatory reporting requirements are met to prevent non-compliance.
10. Ensuring compliance with all Molina Health Plans through report creation and execution.
11. Serving as a backup to the Senior Reporting Analyst.
12. Performing peer reviews for reporting activities.
13. Healthcare experience, Excel proficiency, and preferred Healthcare Fraud Shield knowledge.

Job Qualifications

Required Education

Associate Degree or equivalent combination of education and experience.

Required Experience/Skills

Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields.

Preferred Experience

Minimum 1 year in regulatory reporting; 2-4 years working in managed care; 3-5 years in healthcare regulatory, compliance, or auditing.

Physical Demands

Office environment, minimal hazards, ability to sit long periods. Accommodations available for disabilities.

Interested Molina employees should apply via the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Pay Range: $21.82 - $51.06/hourly. Compensation varies by location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Contract
• Job functions: Research, Analyst, IT
• Industries: IT Services, Consulting