Marketing research Jobs in Cedar Rapids, IA

Claims Research Analyst

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.

Essential Job Duties

• Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.
• Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
• Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries / complaints, or legal requests.
• Assists with reducing rework by identifying and remediating claims processing issues.
• Locates and interprets claims-related regulatory and contractual requirements.
• Tailors existing reports and / or available data to meet the needs of claims projects.
• Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.
• Applies claims processing and technical knowledge to appropriately define a path for short / long-term systematic or operational fixes.
• Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.
• Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.
• Works collaboratively with internal / external stakeholders to define claims requirements.
• Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.
• Fields claims questions from the operations team.
• Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
• Appropriately conveys claims-related information and tailors communication based on targeted audiences.
• Provides sufficient claims information to internal operations teams that communicate externally with providers and / or members.
• Collaborates with other functional teams on claims-related projects, and completes tasks within designated / accelerated timelines to minimize provider / member impacts and maintain compliance.
• Supports claims department initiatives to improve overall claims function efficiency.

Required Qualifications

Preferred Qualifications

Pay Range : $21.65 - $46.42 / HOURLY

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.