Molina Healthcare

Analyst, Business

Molina Healthcare$70K — $95K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 3+ years in healthcare, managed care, or Payment Integrity, with knowledge of claims adjudication and editing
  • Ability to interpret and validate rule-based logic and configuration outputs
  • Strong analytical and problem-solving skills, managing multiple states and timelines
  • Effective communicator experienced in leading discussions and organizing regulatory updates
  • Capability to work independently in a remote setting with proficiency in Microsoft Office tools

Responsibilities

  • Lead interpretation of regulatory and business requirements into actionable configurations
  • Own the full lifecycle of edit development from intake to maintenance
  • Review and validate rule-based logic for accuracy and alignment
  • Partner with IT and cross-functional teams for deployments and issue resolution
  • Drive working sessions and governance for clarity and traceability
  • Monitor regulatory sources for alignment with requirements
  • Conduct root-cause analysis on configuration and performance issues

Benefits

  • Competitive benefits and compensation package offered
Full Job Description
Job Description

JOB DESCRIPTION

Job Summary

This Business Analyst role interprets regulatory and business requirements and translates them into actionable edit configurations within pre-pay platforms. This role partners with Payment Integrity, Health Plans, IT, vendors, and SMEs to ensure accurate implementation and optimization of claims editing solutions. The position requires strong ownership, advanced analytical skills, and hands-on validation of rule-based logic to ensure alignment with business intent and financial outcomes. It also supports system development, maintenance, and applicable governance activities.

JOB DUTIES
  • Lead interpretation of state, CMS, and health plan requirements and translate them into business rules, edit logic, configuration strategies, and supporting documentation
  • Own the full lifecycle of edit development, including requirements intake, configuration, validation, deployment, and ongoing maintenance
  • Review, validate, and refine rule-based logic or code to ensure accuracy, completeness, and alignment with regulatory and business intent
  • Partner with IT, vendors, and cross-functional teams to ensure successful deployment, issue resolution, and alignment on requirements and solutions
  • Lead working sessions, governance processes, and interpretation reviews to drive cross-functional clarity and maintain traceability from requirement to outcome
  • Monitor regulatory sources and system updates to ensure consistent alignment with coverage, reimbursement, and processing requirements
  • Perform advanced root-cause analysis on logic gaps, configuration defects, performance issues, and state-requirement-related problems
  • Communicate requirement interpretations, changes, and impacts to health plans, product teams, and core functional areas

JOB QUALIFICATIONS

Required Qualifications
  • 3+ years of experience in healthcare, managed care, or Payment Integrity, with strong knowledge of claims adjudication, claims editing, reimbursement logic, and related platforms
  • Proven ability to interpret, review, and validate rule-based logic or configuration outputs, and synthesize complex requirements into clear business and configuration direction
  • Strong analytical, problem-solving, and critical-thinking skills, including the ability to manage multiple states, lines of business, and aggressive timelines
  • Effective communicator with experience leading requirement discussions, influencing cross-functional teams, and organizing regulatory data and real-time policy updates
  • Ability to work independently in a remote environment, collaborate across time zones, and utilize Microsoft Office tools (Word, Excel, Outlook, Teams) proficiently

Preferred Qualifications
  • Familiarity with structured logic, scripting, or rule-based configuration tools
  • Knowledge and experience with federal regulatory policy resources, including Centers for Medicare & Medicaid Services (CMS), the Affordable Care Act (ACA), and Medicaid state requirements
  • Experience developing and maintaining requirement documents related to edit configurations
  • Experience conducting analysis to identify root cause and support problem management related to state requirements
  • Experience leading UAT, validation cycles, and production deployments
  • Medical coding knowledge (CPT/HCPCS/ICD) or 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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

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