Lead, Core Operations at Molina Healthcare

Long Beach, California, United States -

Full Time

Start Date

Immediate

Expiry Date

26 Aug, 26

Salary

0.0

Posted On

28 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Benefit Interpretation, Provider Services, Provider Enrollment, Escalation Management, Troubleshooting, Workflow Coordination, Quality Improvement, Mentoring, Customer Service, Medicare Knowledge, Medicaid Knowledge, Marketplace Plans Knowledge, Time Management, Cross-collaborative Communication, Microsoft Office

Industry

Hospitals and Health Care

Description

JOB DESCRIPTION Job Summary Provides lead level support for core operations activities including claims processing, benefit interpretation, provider services, provider enrollment, etc., ensuring functional operations and contractual compliance. Essential Job Duties • 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. Job 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. #PJCore #LI-AC1 To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Responsibilities

Provides lead-level support for core operations including claims processing, benefit interpretation, and provider services. Manages departmental escalations, coordinates daily workflows, and serves as a subject matter expert for team training and mentoring.