Senior Business Analyst - Remote

Molina Healthcare•Long Beach, CA

1d•Remote

About The Position

Provides senior-level support for the accurate and timely intake, interpretation, and translation of regulatory, business, and functional requirements. This role requires strong depth in claims operations and policy interpretation, along with a solid, practical understanding of Availity as a key provider-facing platform. The position partners closely with claims operations, health plans, product, and digital channel teams to ensure claims-related requirements are clearly defined, governed, and implemented in support of compliant and efficient systems solutions.

Requirements

Deep expertise in managed care claims operations, including claims processing, reimbursement methodologies, and a working knowledge of Availity as a provider-facing platform for claims submission, status, and payment inquiries.
Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning.
Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
Proven ability to lead complex, cross-organizational projects independently, navigating ambiguity with minimal direction.
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 ability 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.
At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.
Policy/government legislative review knowledge
Strong analytical and problem-solving skills
Familiarity with administration systems
Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams
Previous success in a dynamic and autonomous work environment

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

Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices.
Monitors regulatory sources to ensure all updates are aligned. Uses comprehensive background to navigate analytical problems, including: clearly defining and documenting their unique specifications. Leads coordinated development and ongoing management / interpretation review process, committee structure and timing with key partner organizations.
Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
Provides status and updates to health plan/product team partners, senior management and stakeholders.
Partners with claims operations, product, IT, and digital channel teams to ensure claims requirements are accurately reflected across systems, including provider-facing tools such as Availity.
Applies working knowledge of Availity functionality to support claims-related workflows, including claims submission, claims status, remittance, and payment inquiries, ensuring requirements align with platform capabilities.
Coordinates analysis, impact assessment, and implementation activities for claims-related changes.
Engages with claims leadership and Plan Support functions to review compliance-driven issues and support benefit and reimbursement planning.