Appeals & Grievances Regulatory Analyst

About Molina Healthcare

Molina Healthcare is a leading healthcare organization committed to providing accessible, high-quality healthcare services to diverse communities. With a focus on innovative solutions and member-centric care, Molina strives to improve health outcomes through comprehensive programs and dedicated support. The company operates across multiple states, partnering with various health plans, providers, and stakeholders to deliver tailored healthcare solutions that meet regulatory standards and address the unique needs of its members.

About the Appeals & Grievances Regulatory Analyst Role

The Appeals & Grievances Regulatory Analyst plays a critical role in ensuring the accurate and timely interpretation of regulatory and functional requirements related to appeals, grievances, coverage, reimbursement, and processing functions. This position supports the development and maintenance of system solutions by coordinating with stakeholders, subject matter experts, and governance committees. The analyst is responsible for developing requirement documents, monitoring regulatory updates, and facilitating communication across teams to ensure compliance and operational efficiency. The role demands strong analytical skills, attention to detail, and the ability to manage multiple projects within a dynamic environment, often working remotely and across different time zones.

Qualifications

• Minimum of 2 years of experience in managed care, health insurance, or a related field.
• Knowledge of policy and government legislative review processes.
• Strong analytical and problem-solving skills.
• Proficiency in Microsoft Office Suite including Word, Excel, Outlook, and Teams.
• Experience working in a fast-paced, autonomous environment.
• Effective communication skills, both oral and written.
• Ability to synthesize complex regulatory requirements clearly and concisely.
• Experience maintaining regulatory data and tracking policy changes in real-time.
• Self-motivated with initiative and proactive problem resolution skills.
• Ability to work independently and collaborate with remote teams across different time zones.

Responsibilities

• Develop and maintain requirement documentation related to coverage, reimbursement, and system changes to ensure compliance with regulatory standards and health plan requirements.
• Monitor sources for regulatory updates and ensure all changes are incorporated appropriately.
• Lead the development and management of review processes, committee structures, and timelines with key partner organizations.
• Conduct root cause analysis and support problem management related to state-specific requirements.
• Communicate requirement interpretations and updates to health plans, product teams, and other functional areas to ensure alignment and approval.
• Support resolution of requirement interpretation inconsistencies and handle related complaints.
• Provide self-organized reporting to keep leadership informed of ongoing work efforts and potential impacts on financials.
• Collaborate with operations leadership and Plan Support to review compliance issues for benefit planning and regulatory adherence.

Benefits

• Competitive salary and comprehensive benefits package.
• Opportunities for professional development and career growth.
• Flexible remote work environment.
• Health, dental, and vision insurance coverage.
• Paid time off and holiday leave.
• Supportive and inclusive workplace culture.

Equal Opportunity

Molina Healthcare is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based on race, religion, gender, sexual orientation, age, disability, or any other protected status. All qualified applicants are encouraged to apply.

Key skills/competency

• Regulatory Compliance
• Appeals & Grievances
• Managed Care
• Health Insurance Regulations
• Requirement Documentation
• Root Cause Analysis
• Policy Interpretation
• Stakeholder Coordination
• Communication Skills
• Microsoft Office Suite