Analyst, Configuration Information Management

Claims Regulatory Analyst

Responsible for timely intake and accurate interpretation of regulatory requirements related to benefit coverage, service reimbursement, and processing of a claim to support system solutions development and maintenance for claim payment. This role includes coordination with stakeholders and subject matter experts on partner teams and support of governance committees where applicable.

Duties and Responsibilities :

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable claim adjudication areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements
• Monitors regulatory sources to ensure all updates to products and payment are in alignment with contractual baselines
• Communicates requirement interpretations and changes to health plans and various impacted corporate core functional areas for coverage and payment requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices
• Provide support for claim and / or requirement interpretation inconsistencies and inquiries
• Self-organized reporting to ensure health plans and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials
• Maintains tickets and work tracking tools
• Maintains relationships with Health Plans and Corporate teams to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning

Knowledge, Skills and Abilities :

Required Experience :

Preferred Experience :

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