Analyst, Configuration Information Management

Molina Healthcare•Long Beach, CA

1d•Remote

About The Position

Responsible for timely intake and accurate interpretation of regulatory requirements related to benefit coverage, service reimbursement, and processing of a claim to support system solutions development and maintenance for claim payment. This role includes coordination with stakeholders and subject matter experts on partner teams and support of governance committees where applicable.

Requirements

Policy/government legislative review knowledge
Strong interpersonal and (oral and written) communication skills and ability to communicate with those 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-motivated and able to take initiative, identify, communicate, and resolve potential problems
Ability to work independently in a remote environment
Ability to work with those in other time zones than your own
Ability to maintain requirements for multiple States
2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field
Strong analytical and problem-solving skills
Robust knowledge of Office Product Suite including Word, Excel including pivot tables and VLOOKUP's, Outlook and Teams

Nice To Haves

Minimum Bachelor's Degree or equivalent experience; preferred focus of study in public health, public policy related to insurance and managed care or business
Previous success in a dynamic and autonomous work environment
Project implementation experience
Knowledge and experience with federal regulatory policy resources including CMS and the Affordable Care Act
Familiarity with claim administration systems
Familiarity or interest in adoption of AI work tools including Microsoft Copilot

Responsibilities

Develops and maintains requirement documents related to coverage, reimbursement and other applicable claim adjudication areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements
Monitors regulatory sources to ensure all updates to products and payment are in alignment with contractual baselines
Communicates requirement interpretations and changes to health plans and various impacted corporate core functional areas for coverage and payment requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices
Provide support for claim and/or requirement interpretation inconsistencies and inquiries
Self-organized reporting to ensure health plans and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials
Maintains tickets and work tracking tools
Maintains relationships with Health Plans and Corporate teams to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning