Associate Analyst, Claims Research

Associate Analyst, Claims Research at Molina Healthcare

Provides entry level analyst support for claims research activities. This role plays a pivotal role in ensuring the timely and accurate resolution of provider-submitted claims issues. This role requires a keen understanding of medical claims processing, strong analytical skills, and the ability to effectively triage issues to the appropriate department for further investigation or correction. This is a production-based role, with clear expectations for meeting production and quality standards.

Job Duties

• Reviews and analyzes claims-related issues submitted by providers to identify potential root causes quickly and accurately.
• Triages issues based on type and complexity, assigning them to the appropriate department or team for further research or correction.
• Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate assessments.
• Meets quality and production goals.
• Maintains detailed records of claim reviews and resolutions.
• Identifies trends in submitted issues to inform process improvements and reduce recurring errors.
• Provides feedback and recommendations for process improvements.
• Completes training and development activities to stay current with industry standards and best practices.

Job Qualifications

REQUIRED QUALIFICATIONS:

• At least 1 year of experience in claims processing or operations or equivalent combination of relevant education and experience
• Basic knowledge of medical billing and basic claims processes.
• Problem-solving skills
• Verbal and written communication skills and ability to collaborate
• Ability to work independently and as part of a team
• Microsoft Office suite/applicable software program(s) proficiency

Preferred Qualifications

• Experience with process improvement methodologies.
• Knowledge of industry regulations and compliance standards.
• Familiarity with systems used to manage claims inquiries and adjustment requests
• Understanding of billing and coding procedures
• Experience with Medicaid, Medicare, and Marketplace claims

Key skills/competency

• Claims processing
• Medical billing
• Problem-solving
• Data analysis
• Regulatory compliance
• Process improvement
• Issue resolution
• Quality assurance
• Record keeping
• Microsoft Office