Senior business analyst jobs in Caldwell, ID

USM Business Systems Inc. is a quickly developing worldwide System Integrator, Software and Product Development, IT Outsourcing and Technology assistance supplier headquartered in Chantilly, VA with off-shore delivery centers in India. We offer world-class ability in giving most astounding quality and administrations through industry best practices planned to convey remarkable worth to our customers. Utilizing our industry knowledge, administration service offering expertise and innovation abilities, we distinguish new business and innovation slants and create answers for help customers around the globe, giving top of the line solid and practical IT benefits which are cost effective services. Established in 1999, the organization has corner qualities in building and dealing with a Business Oriented IT environment with rich involvement in technology innovation, ERP and CRM counselling, Product Engineering, Business Intelligence, Data Management, SOA, BPM, Data Warehousing, SharePoint Consulting and IT Infrastructure. Our other offerings include modified solutions and administrations in ERP, CRM, Enterprise architecture, offshore advisory services ,e-commerce, Social , Mobile, Cloud, Analytics (SMAC) and DevOps. USM, a US ensured Minority Business Enterprise (MBE) is perceived as one of the fastest developing IT Systems Integrator in the Washington, DC zone. Most as of late, USM was positioned #9 on the rundown of the Top administrations organizations in the DC Metro Area - Washington Business Journal (2011). We are a project-driven firm that reliably meets the IT needs of our State and Government customers through development and business keenness. Job Description Role Description: • Participate in a team of individuals in the Automation Integration Bureau functioning as a Business Analyst supporting customer focused testing of several large automated systems within the Division of Welfare • Works as a customer advocate on a business testing team supporting validation of software developed incrementally by several product development teams • Support the testing team in documenting test plans: objectives, scope, approach, assumptions, dependencies, risks and schedule for a particular release • Works closely with engineers developing automated tests to ensure alignment with customer needs, process flows and system requirements • Works closely with business testers developing manual User Acceptance Tests to ensure alignment with customer needs, process flows and system requirements. • Reviews, analyzes, and evaluates business systems and user needs • Facilitates the discovery of as-is and to-be business processes • Documents business processes in a manner that facilitates long term maintenance, business process automation, and process improvement Skills and knowledge in the following areas: • Supporting agile teams by collaborating with business managers, subject matter experts and specialists in policy and operations to ensure automated functionality meets business requirements, implementation parameters, readiness plan components, and timelines • Coordinating and facilitating the gathering of business and system requirements in support of incremental and iterative system development • Developing key deliverables within the agile development process; user stories, acceptance criteria, business-focused test scenarios, solution models, as-is and to-be process models, user story maps, user personas, light-weight functional and non-functional requirements and product roadmaps • Working with customer business units to understand their business processes • Performing workflow design and process improvement • Understanding and reviewing test models for product test and release control (plans, data, and scripts) • Understanding and reviewing test plans, test scripts, test cases and links that connect to requirements and done criteria • Performing testing on software applications and/or websites • Writing and executing SQL statements to analyze data in support of business analysis and testing • Demonstrating strong organizational and communication skills and attention to detail • Creating and maintaining high-quality documentation of all relevant specifications, systems, and procedures Preferred Skills/Experience (Any of these is a plus) • Experience with automated testing tools • Working knowledge of a modern welfare eligibility case management system • Experience working with government agencies Additional Information If you are interested in above position, please share your updated resume to ************************** or can directly call me on ************.

Our client, a leading organization in the healthcare industry, is seeking a Business Analyst to join their team. As a Business Analyst, you will be part of the Business Operations department supporting procurement and data analysis teams. The ideal candidate will have strong analytical skills, attention to detail, and a proactive mindset which will align successfully in the organization. **Job Title:** Business Analyst **Location:** On-Site in Meridian, ID **Pay Range:** $22.67 hourly **Shift:** Part Time - 20 hours a week **What's the Job?** + Report, analyze, and make observations about data and processes + Review and understand data; support regular updates to metrics + Assist in implementing metric improvements for Strategic and Operational Procurement + Understand the Master Data environment; support accuracy, timeliness, and updates as necessary for procurement processes + Contribute as a member of project teams **What's Needed?** + Bachelor's degree in a technical discipline or related field, or equivalent work experience + Strong analytical and problem-solving skills + Ability to interpret and report on data + Detail-oriented with a focus on accuracy and timeliness + Ability to work under supervision on routine tasks and smaller projects **What's in it for me?** + Opportunity to develop foundational skills in business analysis and data management + Engagement in meaningful projects that impact organizational processes + Supportive work environment with opportunities for growth + Participation in a diverse and inclusive workplace + Access to comprehensive onboarding and training programs **Upon completion of waiting period associates are eligible for:** + Medical and Prescription Drug Plans + Dental Plan + Supplemental Life Insurance + Short Term Disability Insurance + 401(k) If this is a role that interests you and you'd like to learn more, click apply now and a recruiter will be in touch with you to discuss this great opportunity. We look forward to speaking with you! **About ManpowerGroup, Parent Company of: Manpower, Experis, Talent Solutions, and Jefferson Wells.** _ManpowerGroup (NYSE: MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We develop innovative solutions for hundreds of thousands of organizations every year, providing them with skilled talent while finding meaningful, sustainable employment for millions of people across a wide range of industries and skills. Our expert family of brands -_ **_Manpower, Experis, Talent Solutions, and Jefferson Wells_** _- creates substantial value for candidates and clients across more than 75 countries and territories and has done so for over 70 years. We are recognized consistently for our diversity - as a best place to work for Women, Inclusion, Equality and Disability and in 2023 ManpowerGroup was named one of the World's Most Ethical Companies for the 14th year - all confirming our position as the brand of choice for in-demand talent._ ManpowerGroup is committed to providing equal employment opportunities in a professional, high quality work environment. It is the policy of ManpowerGroup and all of its subsidiaries to recruit, train, promote, transfer, pay and take all employment actions without regard to an employee's race, color, national origin, ancestry, sex, sexual orientation, gender identity, genetic information, religion, age, disability, protected veteran status, or any other basis protected by applicable law.

Job Title: IT - SAP Senior Functional Analyst (Transportation Management) Division: Corporate Posting Area: IT + Information Systems Job Title: SAP Senior Functional Analyst (Transportation Management) Location(s): St. Louis, MO | Lawrenceville, GA | Meridian, ID | West Des Moines, IA Starting Salary: $85,000 - $130,000 (depending on experience) Employment Type: Full-Time, Salary Work Environment: Hybrid (4 days in-office, 1 days remote) Summary of Company Benefits: * Health, Dental, and Vision Insurance * Health Savings Account (HSA) * Flexible Spending Account (FSA) * 401(k) with an Employer Match * Group Term Life Insurance and AD&D * Employer Paid Long-Term & Short-Term Disability * Voluntary Supplemental Hospital and Accident Plans * Employee Assistance Program * 8 Company Paid Holidays & 1 Floating Holiday * Progressive Paid Time Off (PTO) Accruals * Annual Salary Incentive Bonus About Woodgrain: Woodgrain is one of the top millwork operations in the world, with locations throughout the United States and Chile. With 70 years of quality manufacturing craftsmanship and service, Woodgrain is a top producer of mouldings, doors, and windows, as well as a premier distributor of specialty building products. Woodgrain Inc. is headquartered in Fruitland, Idaho with six divisions and over 45 manufacturing and warehouse facilities in the United States and South America. Since 1954, Woodgrain is proud to be family owned and operated. Job Summary: The IT SAP Functional Analyst (TM) is responsible for designing, building, and delivering the configuration of Transportation Management modules, technical solutioning for integrating software applications and SAP implementations, and working closely with the Data Integration team to develop interfaces and automate solutions. This role will also contribute to the implementation and maintenance of systems that support Woodgrain's SAP Transportation Management functions in accordance with the Project Management Life Cycle and will be heavily involved in blueprinting, partnering with the business users and subject matter experts to analyze, define, and implement lean business processes and system solutions that will be utilized across the Woodgrain organization during SAP implementations for mergers, acquisitions and upgrades, as well as the integration of non-SAP solutions with SAP. Duties & Responsibilities: * Configure Transportation Management Modules * Be the subject matter expert for SAP Transportation Management (TM) with an emphasis on Freight Planning (e.g., road, rail, ocean, air), Load Building, Freight Units/Order Building, Freight Forwarding, Carrier Determination, Freight Agreements, Tendering, and General Transportation Management. * Lead or participate in blueprinting sessions to define scope, gather business requirements, create concepts and designs that meet business needs, and document detailed specifications for the development of custom programs, testing, and implementing the automated solutions. * Document requirements for conversions, upgrades, interfaces, business logic, reports, forms, and workflow and develop technical solutions as defined and documented during blueprinting. * Manage and perform functional, unit, regression, and integration testing for go-lives and software updates. * Deliver multiple projects (sometimes concurrently) by effectively communicating and collaborating with cross-functional teams including IT Applications, Infrastructure, SAP Basis, Security, Data Integration, Architecture, Business Resource Managers, the Business, and Management. * Provide customer service to end users by logging, routing, and resolving incoming requests for TM-related process or system issues and bugs. * Develop, document and revise standard operating procedures, user documentation, business process workflows and training guides Requirements: * Bachelor's degree in a technical areas such as Computer Science, Information Technology, or Business. Equivalent training and experience can be considered in lieu of a degree. * At least 5 years of previous experience working on SAP with the Transportation Management environment. (i.e., Freight Planning (e.g., road, rail, ocean, air), Load Building, Freight Units/Order Building, Freight Forwarding, Carrier Determination, Freight Agreements, Tendering, and General Transportation Management) * Must have assisted in 1 large-scale ERP implementation. * Strong understanding of an experience with TM terminology and methodology. (i.e., Multiple Mode Stage, Zone and Lane Development, Default Routes, BOBF, PPF, ATP, Tendering, etc.) * Knowledge of SAP Transportation Management (TM) configuration and integration points with the other SAP modules (i.e., FI/CO, MM, SD, and WM). * Experience with configuration in SAP ECC 6.0 and/or S/4 HANA Additional Skills: * Excellent analytical skills to interpret complex, cross-functional requirements and challenges * Ability to develop process maps, project plans, cutover and conversion plans, technical specifications, user guides and other documentation * Ability to work efficiently with team members from different geographical locations and expertise backgrounds. * Strong interpersonal, listening, written, and verbal communication skills. * Commitment to a strong work ethic and coordinating within a rapidly changing environment and handling unexpected solutions. * Ability to effectively communicate in English, both verbally and in writing. Additional languages preferred. Physical Demands: The physical demands and work environment for this role align with those of a standard office setting. While performing job duties, the employee may occasionally need to stand, walk, sit, use hands for handling objects, tools, or controls, reach with hands and arms, climb stairs, balance, stoop, kneel, crouch, or crawl, as well as talk and hear. This role may occasionally require lifting or moving up to 25 pounds. Travel: This position may require travel to other Woodgrain locations, expected travel time is 15%. Applications will be accepted until the position has been filled ____________________________________________________________

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. + Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. + Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. + Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. + Where applicable, codifies the requirements for system configuration alignment and interpretation. + Provides support for requirement interpretation inconsistencies and complaints. + Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. + Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. + Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. + Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and recommendations to leadership to drive continuous improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in Excel + Knowledge in QNXT preferred + Strong communication and stakeholder management skills with ability to influence across teams. **KNOWLEDGE/SKILLS/ABILITIES** + Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. + Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. + Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. + Ability to concisely synthesize large and complex requirements. + Ability to organize and maintain regulatory data including real-time policy changes. + Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. + Ability to work independently in a remote environment. + Ability to work with those in other time zones than your own. **JOB QUALIFICATIONS** **Required Qualifications** + At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. + Policy/government legislative review knowledge + Strong analytical and problem-solving skills + Familiarity with administration systems + Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams + Previous success in a dynamic and autonomous work environment **Preferred Qualifications** + Project implementation experience + Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding certification. 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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. + Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. + Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. + Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. + Where applicable, codifies the requirements for system configuration alignment and interpretation. + Provides support for requirement interpretation inconsistencies and complaints. + Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. + Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. + Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. + Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. **KNOWLEDGE/SKILLS/ABILITIES** + Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. + Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. + Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. + Ability to concisely synthesize large and complex requirements. + Ability to organize and maintain regulatory data including real-time policy changes. + Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. + Ability to work independently in a remote environment. + Ability to work with those in other time zones than your own. **JOB QUALIFICATIONS** **Required Qualifications** + At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. + Policy/government legislative review knowledge + Strong analytical and problem-solving skills + Familiarity with administration systems + Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams + Previous success in a dynamic and autonomous work environment **Preferred Qualifications** + Project implementation experience + Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding certification. 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. Pay Range: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Recoveries & Disputes * Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. * Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. * Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. * Provide actionable insights and recommendations to leadership to drive continuous improvement. Skills & Competencies * Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. * In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. * Strong understanding of claim system configurations, payment policies, and audit processes. * Exceptional analytical, problem-solving, and documentation skills. * Ability to translate complex business problems into clear system requirements and process improvements. * Proficiency in Excel * Knowledge in QNXT preferred * Strong communication and stakeholder management skills with ability to influence across teams. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Recoveries & Disputes * Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. * Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. * Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. * Provide actionable insights and recommendations to leadership to drive continuous improvement. Skills & Competencies * Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. * In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. * Strong understanding of claim system configurations, payment policies, and audit processes. * Exceptional analytical, problem-solving, and documentation skills. * Ability to translate complex business problems into clear system requirements and process improvements. * Proficiency in Excel * Knowledge in QNXT preferred * Strong communication and stakeholder management skills with ability to influence across teams. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $77,969 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects. **ESSENTIAL JOB DUTIES:** + Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports. + Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. + Assist retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting. + Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. + Do root cause analysis for business data issues as assigned by the team lead. + Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance. + Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users. + Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. + Develop oneself as HEDIS subject matter expert to help health plan improve performance on underperforming measures. **Job Qualifications** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. + 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design + 5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS. + Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. + 3+ years of experience with Microsoft Azure, AWS, or Hadoop. + 3+ Years of experience with predictive modeling in healthcare quality data. + 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. + 3+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. + 3+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects. **ESSENTIAL JOB DUTIES:** + Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports. + Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. + Assist retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting. + Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. + Do root cause analysis for business data issues as assigned by the team lead. + Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance. + Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users. + Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. + Develop oneself as HEDIS subject matter expert to help health plan improve performance on underperforming measures. **Job Qualifications** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. + 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design + 5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS. + Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. + 3+ years of experience with Microsoft Azure, AWS, or Hadoop. + 3+ Years of experience with predictive modeling in healthcare quality data. + 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. + 3+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. + 3+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects. **ESSENTIAL JOB DUTIES:** + Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports. + Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. + Assist retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting. + Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. + Do root cause analysis for business data issues as assigned by the team lead. + Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance. + Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users. + Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. + Develop oneself as HEDIS subject matter expert to help health plan improve performance on underperforming measures. **Job Qualifications** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. + 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design + 5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS. + Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. + 3+ years of experience with Microsoft Azure, AWS, or Hadoop. + 3+ Years of experience with predictive modeling in healthcare quality data. + 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. + 3+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. + 3+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **KNOWLEDGE/SKILLS/ABILITIES** + Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. + Participates in defect resolution for assigned component + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have experience in Contracts configuration in QNXT or Networx + Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. + Must have knowledge on Medicare payment methods + Experience on Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is required + Medicaid and Duals experience is highly preferred **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred Education** Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. **Preferred Experience** 7-9 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Serves as a subject matter expert on system capabilities, conducting research and root cause analysis to resolve complex business and technical issues. Ensures system configuration aligns with business rules, regulatory requirements, and operational needs. Supports upgrades, releases, and health plan implementations while validating data integrity and recommending improvements to enhance system efficiency and quality. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as a subject matter expert (SME) on NetworX system capabilities, leveraging system knowledge to evaluate configuration options and recommend optimal solutions + Must have configuration experience in NetworX Pricer + Conducts in-depth research and analysis to identify root causes of complex business and system issues, providing clear recommendations for resolution + Participates in defect resolution for assigned component + Designs and facilitates system knowledge training sessions to improve user understanding and operational efficiency + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have healthcare experience. + Experience working with SQL is highly preferred. **JOB QUALIFICATIONS** **Required Education** + Bachelor's Degree or equivalent combination of education and experience **Required Experience** + 5-7 years of provider contract configuration experience **Preferred Education** + Graduate Degree or equivalent experience **Preferred Experience** + 7-9 years provider contract configuration experience + SQL Experience (HIGHLY PREFERRED) + NetworX Pricer experience (HIGHLY PREFERRED) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. KNOWLEDGE/SKILLS/ABILITIES * Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. * Participates in defect resolution for assigned component * Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. * Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. * Participates in the implementation and conversion of new and existing health plans. * Must have experience in Contracts configuration in QNXT or Networx * Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. * Must have knowledge on Medicare payment methods * Experience on Hospital payment methodology & processing is essential * Understanding on hospital claims processing and configuration works * Medicare fee schedule knowledge is required * Medicaid and Duals experience is highly preferred JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. Preferred Education Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. Preferred Experience 7-9 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $141,371 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Serves as a subject matter expert on system capabilities, conducting research and root cause analysis to resolve complex business and technical issues. Ensures system configuration aligns with business rules, regulatory requirements, and operational needs. Supports upgrades, releases, and health plan implementations while validating data integrity and recommending improvements to enhance system efficiency and quality. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as a subject matter expert (SME) on NetworX system capabilities, leveraging system knowledge to evaluate configuration options and recommend optimal solutions + Must have configuration experience in NetworX Pricer + Conducts in-depth research and analysis to identify root causes of complex business and system issues, providing clear recommendations for resolution + Participates in defect resolution for assigned component + Designs and facilitates system knowledge training sessions to improve user understanding and operational efficiency + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have healthcare experience. + Experience working with SQL is highly preferred. **JOB QUALIFICATIONS** **Required Education** + Bachelor's Degree or equivalent combination of education and experience **Required Experience** + 5-7 years of provider contract configuration experience **Preferred Education** + Graduate Degree or equivalent experience **Preferred Experience** + 7-9 years provider contract configuration experience + SQL Experience (HIGHLY PREFERRED) + NetworX Pricer experience (HIGHLY PREFERRED) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **KNOWLEDGE/SKILLS/ABILITIES** + Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. + Participates in defect resolution for assigned component + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have experience in Contracts configuration in QNXT or Networx + Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. + Must have knowledge on Medicare payment methods + Experience on Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is required + Medicaid and Duals experience is highly preferred **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred Education** Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. **Preferred Experience** 7-9 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. KNOWLEDGE/SKILLS/ABILITIES * Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. * Participates in defect resolution for assigned component * Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. * Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. * Participates in the implementation and conversion of new and existing health plans. * Must have experience in Contracts configuration in QNXT or Networx * Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. * Must have knowledge on Medicare payment methods * Experience on Hospital payment methodology & processing is essential * Understanding on hospital claims processing and configuration works * Medicare fee schedule knowledge is required * Medicaid and Duals experience is highly preferred JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. Preferred Education Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. Preferred Experience 7-9 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $141,371 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.