JOB SUMMARY

Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan financial performance. This role focuses on identifying and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed decisions, contribute to health plan strategy, and act as a trusted voice in resolving complex business challenges that impact cost containment and regulatory compliance. The position requires strong business judgment, cross-functional coordination, and shared ownership of high-value deliverables—distinct from a pure data analyst role.

REQUIRED QUALIFICATIONS:

• At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare, or equivalent combination of relevant education and experience
• Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
• Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
• Skilled in Excel and SQL, with the ability to analyze data to inform business decisions—but not dependent on technical guidance for action.
• Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
• Excellent written and verbal communication skills including ability to synthesize complex information.

PREFERRED QUALIFICATIONS:

• Experience with Medicare, Medicaid, and Marketplace lines of business.
• Certified Business Analysis Professional (CBAP), or Certified Coding Specialist (CCS) certification.
• Project Management Experience
• Familiarity with Medicaid-specific Scorable Action Items (SAIs), Operational Cost Management Efforts, Payment Integrity programs, and regulatory/compliance adherence.
  To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
  Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $155,508 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

ABOUT US

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
JOB TYPE Full Time