Associate Analyst, Claims Research

**Job Description** **Job Summary** Provides entry level analyst support for claims research activities. This role plays a pivotal role in ensuring the timely and accurate resolution of provider-submitted claims issues. This role requires a keen understanding of medical claims processing, strong analytical skills, and the ability to effectively triage issues to the appropriate department for further investigation or correction. This is a production-based role, with clear expectations for meeting production and quality standards. **Job Duties** + Reviews and analyzes claims-related issues submitted by providers to identify potential root causes quickly and accurately. + Triages issues based on type and complexity, assigning them to the appropriate department or team for further research or correction. + Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate assessments. + Meets quality and production goals. + Maintains detailed records of claim reviews and resolutions. + Identifies trends in submitted issues to inform process improvements and reduce recurring errors. + Provides feedback and recommendations for process improvements. + Completes training and development activities to stay current with industry standards and best practices. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 1 year of experience in claims processing or operations or equivalent combination of relevant education and experience + Basic knowledge of medical billing and basic claims processes. + Problem-solving skills + Verbal and written communication skills and ability to collaborate + Ability to work independently and as part of a team + Microsoft Office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Experience with process improvement methodologies. + Knowledge of industry regulations and compliance standards. + Familiarity with systems used to manage claims inquiries and adjustment requests + Understanding of billing and coding procedures + Experience with Medicaid, Medicare, and Marketplace claims To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.