Senior Analyst, Claims Research

Senior Claims Research AnalystThe Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively.Job Duties:Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projectsAssists with reducing re-work by identifying and remediating claims processing issuesLocate and interpret regulatory and contractual requirementsExpertly tailors existing reports or available data to meet the needs of the claims projectEvaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing errorAct as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirementsLeads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal auditsConducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutionsInterprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processesDevelops, tracks, and/or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on timeProvides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable formatTakes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approachProactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiencyCollaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goalsJob Qualifications:Required Qualifications:5+ years of experience in medical claims processing, research, or a related fieldDemonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project managementAdvanced knowledge of medical billing codes and claims adjudication processesStrong analytical, organizational, and problem-solving skillsProficiency in claims management systems and data analysis toolsExcellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providersProven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environmentMicrosoft office suite/applicable software program(s) proficiencyPreferred Qualifications:Bachelor's Degree or equivalent combination of education and experienceProject managementExpert in Excel and PowerPointFamiliarity with systems used to manage claims inquiries and adjustment requestsTo 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: $80,168 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.