Lead, Core Operations

Molina Healthcare•Long Beach, CA

About The Position

Provides lead level support for core operations activities including claims processing, benefit interpretation, provider services, provider enrollment, etc., ensuring functional operations and contractual compliance.

Requirements

At least 4 years of health care operations/claims/provider services experience, or equivalent combination of relevant education and experience.
Customer service experience.
Knowledge of Medicare, Medicaid, and Marketplace plans.
Experience supporting a Medicaid or large claims processing environment with multi-functional work units and tasks.
Organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.
Effective verbal and written communication skills.
Microsoft Office suite (including Excel), and applicable software programs proficiency.

Responsibilities

Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
Performs daily troubleshooting procedures to support enrollment, disenrollment, claims, and claims support functions as needed.
Coordinates workflow and staffing of day-to-day activities, and assigns and monitors work of staff to adhere to productivity and quality standards.
Participates in or leads quality improvement efforts to improve claims processes and/or policies.
Serves as operations subject matter expert, provides training, mentoring and support to team personnel.