Molina Healthcare
JOB DESCRIPTION
The following information provides an overview of the skills, qualities, and qualifications needed for this role. Job Summary Responsible for planning, developing, and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve issues. KNOWLEDGE/SKILLS/ABILITIES Implements companywide initiatives relevant to Claims Production, including Claims Production, Audit, and Vendor Oversight.
Leads activities supporting claims production, including the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, and Corporate Encounter Team. Provides organizational leadership of claims editing and recovery vendors to manage healthcare costs.
Collaborates with IT and other departments to implement process and system changes for Corporate Operations PMO.
Implements Corporate Configuration of the QNXT system and Care Management application for UM functions within QNXT, ensuring system produces expected costs.
Ensures compliance with state regulatory requirements, maximizes MASS Adjudication within QNXT, improves process quality, reduces G&A costs, and drives positive operational and financial outcomes.
JOB QUALIFICATIONS Required Education Graduate Degree or equivalent combination of education and experience. Required Experience 7-9 years. Preferred Education Graduate Degree or equivalent combination of education and experience. Preferred Experience 10+ years. To all current Molina employees: Please apply through the intranet job listing if interested. Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $140,795 - $274,550 / ANNUAL *Actual compensation may vary based on location, experience, education, and skills.
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The following information provides an overview of the skills, qualities, and qualifications needed for this role. Job Summary Responsible for planning, developing, and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve issues. KNOWLEDGE/SKILLS/ABILITIES Implements companywide initiatives relevant to Claims Production, including Claims Production, Audit, and Vendor Oversight.
Leads activities supporting claims production, including the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, and Corporate Encounter Team. Provides organizational leadership of claims editing and recovery vendors to manage healthcare costs.
Collaborates with IT and other departments to implement process and system changes for Corporate Operations PMO.
Implements Corporate Configuration of the QNXT system and Care Management application for UM functions within QNXT, ensuring system produces expected costs.
Ensures compliance with state regulatory requirements, maximizes MASS Adjudication within QNXT, improves process quality, reduces G&A costs, and drives positive operational and financial outcomes.
JOB QUALIFICATIONS Required Education Graduate Degree or equivalent combination of education and experience. Required Experience 7-9 years. Preferred Education Graduate Degree or equivalent combination of education and experience. Preferred Experience 10+ years. To all current Molina employees: Please apply through the intranet job listing if interested. Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $140,795 - $274,550 / ANNUAL *Actual compensation may vary based on location, experience, education, and skills.
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