Analyst, Business

Molina Healthcare•Long Beach, CA

12d•Remote

About The Position

Responsible for accurate and timely intake and interpretation of regulatory and functional requirements related to coverage, reimbursement, and processing functions, supporting the development and maintenance of systems solutions. The role coordinates with stakeholders and subject matter experts on partner teams and supports governance committees where applicable. The position maintains requirement documentation, monitors updates for alignment, coordinates requirement interpretation and review processes, conducts root-cause analysis, and communicates changes to health plans, product teams, and impacted corporate functions. It also supports compliance reviews, builds Virtual Instructor-Led Training sessions in a Learning Management System, assists with intake triage and reporting activities, and applies automation and AI tools to improve training operations and related workflows.

Requirements

At least 2 years of experience in previous roles in a managed care organization, health insurance, or a directly adjacent field, or an equivalent combination of relevant education and experience.
Strong analytical and problem-solving skills.
Robust knowledge of the Office Product Suite, including Word, Excel, Outlook, and Teams.
Previous success in a dynamic and autonomous work environment.
Ability to maintain relationships with Health Plans/Product Team and Corporate Operations to ensure end-to-end business requirements are documented and interpretations are clear and agreed upon.
Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
Strong interpersonal, oral, and written communication skills, including the ability to communicate with people at all company levels.
Ability to concisely synthesize large and complex requirements.
Ability to organize and maintain regulatory data, including real-time policy changes.
Self-motivation and the ability to take initiative, identify and communicate potential problems, and resolve them.
Ability to work independently in a remote environment.
Ability to work with people in different time zones.

Nice To Haves

Project implementation experience.
Knowledge and experience with federal regulatory policy resources, including the Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA).
Medical Coding certification.

Responsibilities

Develop and maintain requirement documents for coverage, reimbursement, and other applicable system changes, ensuring alignment with regulatory baseline requirements and health plan requirements.
Monitor information sources to ensure updates are aligned.
Lead coordinated development and ongoing management of requirement interpretation reviews, committee structures, and schedules with partner organizations.
Conduct analysis to identify root causes and assist with problem management.
Communicate requirement interpretations and changes to health plans, product teams, and impacted corporate functional areas; support alignment, approvals, and solution traceability through meetings and operational processes.
Prepare and maintain reporting so leadership understands work efforts and the impact of prospective or retrospective requirement changes that may affect financials.
Engage operations leadership and Plan Support functions to review compliance issues for benefit planning.
Build Virtual Instructor-Led Training (VILT) sessions in the Learning Management System (LMS).
Support intake triage, scheduling logistics, and report reconciliation activities.
Identify and apply automation and AI tools to improve processes, streamline workflows, and increase efficiency in training operations and related support activities.