Senior Configuration Oversight Lead for Claims & Audits

Molina Healthcare; Northern (KY); Hybrid; USD 60,000 - 130,000; Full time

Job summary

Molina Healthcare is seeking a lead-level analyst to support configuration oversight for claims and provider databases, ensuring accurate data and adherence to state/federal requirements. The role involves auditing, reporting, and guiding implementation across the SDLC to optimize claims processing.

The ideal candidate has 5+ years of claims auditing experience, strong SQL/PowerBI skills, and deep knowledge of provider contracting, network management, and benefits related to audits.

Qualifications

• 5+ years of claims auditing experience in a health care operations setting (Medicaid/Medicare/Marketplace) or equivalent.
• Expert understanding of claims processes and auditing.
• Strong analytical and critical-thinking skills.

Responsibilities

• Interpret end-to-end business requirements to ensure state/federal compliance.
• Create reporting tools to communicate audit results and findings.
• Write complex ad-hoc reports for configuration/claims.
• Validate accuracy of configuration scripts and reports.
• Lead peer review processes and oversee complex configurations.
• Communicate audit findings in meetings and written formats.
• Guide solutions during SDLC with technical and business resources.
• Understand Molina claims lifecycle and related processes.

Skills

SQL

PowerBI

Powerquery

Tools

MS Access

Job description

Molina Healthcare is seeking a lead-level analyst to support configuration oversight for claims and provider databases, ensuring accurate data and adherence to state/federal requirements. The role involves auditing, reporting, and guiding implementation across the SDLC to optimize claims processing.

The ideal candidate has 5+ years of claims auditing experience, strong SQL/PowerBI skills, and deep knowledge of provider contracting, network management, and benefits related to audits.