Analyst, Business

Molina Healthcare•Long Beach, CA

11d•Remote

About The Position

Responsible for the accurate and timely intake and interpretation of regulatory and functional requirements—including requirements related to coverage, reimbursement, and processing—to support 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 Analyst develops and maintains requirements documentation, monitors sources for updates, and leads coordinated requirement development and interpretation processes with partner organizations. The role also analyzes root causes, communicates interpretations and changes to health plans and corporate teams, reports on work and potential financial impacts, supports compliance-related benefit planning, and assists with training operations, intake triage, scheduling, and reporting. The position identifies and applies automation and AI tools to improve processes and efficiency.

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 Microsoft Office products, including Word, Excel, Outlook, and Teams.
Previous success in a dynamic and autonomous work environment.
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 in all positions of the company.
Ability to concisely synthesize large and complex requirements.
Ability to organize and maintain regulatory data, including real-time policy changes.
Self-motivation and 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 other time zones.

Nice To Haves

Project implementation experience.
Knowledge and experience with federal regulatory policy resources, including 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, aligning them with regulatory baseline and health plan requirements.
Monitor sources to ensure requirement updates are aligned.
Lead coordinated development and ongoing management of the requirement interpretation and review process, including committee structure and timing 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 to align interpretations, obtain approvals, and support solution traceability.
Provide regular reporting so leadership understands work efforts and the impacts of prospective or retrospective requirement changes, including potential financial impacts.
Engage with operations leadership and Plan Support functions to review compliance-based 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.