Senior Analyst, Business (supports Omni Channel Customer Experience)

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

Job summary

Molina Healthcare is seeking a senior-level Business Analyst to translate regulatory, clinical and business needs into effective applications and processes. You will collaborate with health plans, product teams and operations to deliver value while controlling costs.

You will lead requirements development, ensure regulatory alignment, and communicate interpretations across stakeholders, helping implement changes across states and products with strong attention to detail and traceability.

Qualifications

• 4+ years in managed care, health insurance, or related field.
• Policy/government legislative review knowledge.
• Strong analytical and problem-solving skills.
• Familiarity with administration systems.
• Office Suite (Word, Excel, Outlook, Teams) proficiency.
• Experience in dynamic, autonomous work environments.

Responsibilities

• Develops and maintains requirement documents for coverage, reimbursement, and system changes aligned to regulatory baselines.
• Monitors regulatory sources to align updates and advise cost-saving opportunities.
• Leads development and interpretation review process with partner organizations.
• Communicates interpretations to health plans and corporate areas for alignment.
• Codifies requirements for system configuration alignment.
• Supports interpretation inconsistencies and complaints.
• Assists with standards for requirement solutions and improvements.
• Self-organized reporting to keep leadership informed of changes.
• Coordinates teams for analysis and implementation of changes impacting the product.
• Engages with operations leadership to review compliance-based issues for benefit planning.

Skills

Regulatory knowledge

Analytical skills

Communication skills

Remote work ability

Independent work

Education

Bachelor's degree or equivalent

Tools

Office Suite

Job description

JOB DESCRIPTION

JOB SUMMARY

Provides senior-level support for enterprise projects by translating regulatory, functional, and business needs into effective application and operational solutions. Collaborates with business and technical stakeholders to improve processes, manage change, reduce costs, and deliver business value.

JOB DUTIES

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements.
• Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings.
• Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements.
• Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices.
• Where applicable, codifies the requirements for system configuration alignment and interpretation.
• Provides support for requirement interpretation inconsistencies and complaints.
• Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible.
• Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials.
• Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product.
• Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.

KNOWLEDGE/SKILLS/ABILITIES

• Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning.
• Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
• Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company.
• Ability to concisely synthesize large and complex requirements.
• Ability to organize and maintain regulatory data including real-time policy changes.
• Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems.
• Ability to work independently in a remote environment.
• Ability to work with those in other time zones than your own.

JOB QUALIFICATIONS

Required Qualifications

• At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.
• Policy/government legislative review knowledge
• Strong analytical and problem-solving skills
• Familiarity with administration systems
• Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams
• Previous success in a dynamic and autonomous work environment

Preferred Qualifications

• Project implementation experience
• 2+ years of experience in customer-facing web/portal product ownership or development.
• Reporting and analytics experience

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.