Lead Analyst, Payment Integrity - REMOTE

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 deliverablesdistinct from a pure data analyst role.

Job Duties

Business Leadership & Operational Ownership

• Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, Overpayment Recovery which improves encounter submissions, reduces General and Administrative expenses (G&A) costs, and continues to drive positive operational and financial outcomes for all PI solutions.
• Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure Health Plan SAI targets are met.
• Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight.
• Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
• Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.
• Partners with Network to communicate recovery projects so that provider relations can be informed and respond to questions from providers.

Strategic Business Analysis

Applied Analytical Support

Job Qualifications

Required Qualifications :

Preferred Qualifications :

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