Associate Analyst, Claims Research

Molina Healthcare•Long Beach, CA

About The Position

Job Summary Provides entry level analyst support for claims research activities. This role plays a pivotal role in ensuring the timely and accurate resolution of provider-submitted claims issues. This role requires a keen understanding of medical claims processing, strong analytical skills, and the ability to effectively triage issues to the appropriate department for further investigation or correction. This is a production-based role, with clear expectations for meeting production and quality standards.

Requirements

At least 1 year of experience in claims processing or operations or equivalent combination of relevant education and experience
Basic knowledge of medical billing and basic claims processes.
Problem-solving skills
Verbal and written communication skills and ability to collaborate
Ability to work independently and as part of a team
Microsoft Office suite/applicable software program(s) proficiency

Nice To Haves

Experience with process improvement methodologies.
Knowledge of industry regulations and compliance standards.
Familiarity with systems used to manage claims inquiries and adjustment requests
Understanding of billing and coding procedures
Experience with Medicaid, Medicare, and Marketplace claims

Responsibilities

Reviews and analyzes claims-related issues submitted by providers to identify potential root causes quickly and accurately.
Triages issues based on type and complexity, assigning them to the appropriate department or team for further research or correction.
Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate assessments.
Meets quality and production goals.
Maintains detailed records of claim reviews and resolutions.
Identifies trends in submitted issues to inform process improvements and reduce recurring errors.
Provides feedback and recommendations for process improvements.
Completes training and development activities to stay current with industry standards and best practices.