Molina Healthcare

Payment Integrity Manager - REMOTE

Molina Healthcare$80K — $120K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • 5+ years in healthcare subrogation or legal recovery, handling diverse case types.
  • 3+ years in a leadership role managing teams and vendors.
  • Experience in a Managed Care Organization (MCO) or health plan setting.
  • Proven track record in managing complex vendor relationships and recovery models.
  • In-depth knowledge of federal and state regulations governing subrogation and compliance activities.
  • Strong analytical, negotiation, communication, and leadership skills.

Responsibilities

  • Oversee internal teams and external vendors in subrogation operations.
  • Directly manage the identification and resolution of various subrogation cases.
  • Develop policies and workflows to enhance subrogation operations across Medicaid, Medicare, and Marketplace.
  • Collaborate across departments to synchronize recovery efforts and ensure compliance.
  • Monitor vendor performance and case outcomes to achieve recovery targets.
  • Conduct quality assurance reviews of subrogation case files and provide necessary coaching.
  • Analyze recovery trends and recommend improvements to operational efficiency.

Benefits

  • Opportunity for training and professional development in a specialized field.
  • Exposure to diverse subrogation scenarios, enhancing career growth.
  • Collaboration with multiple departments, broadening organizational knowledge.
  • Direct impact on financial performance and operational effectiveness.
  • Leadership role with potential to shape subrogation practices and policies.
Full Job Description
Job Description

Job Summary:
The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare, and Marketplace lines of business. This includes direct management of internal teams and external vendors handling both first-pass and second-pass recovery efforts. The role requires experience across a wide range of subrogation case types-including automobile-related claims (e.g., no-fault/PIP), workers' compensation, general liability, medical malpractice, and mass tort-with the ability to manage and optimize recoveries across all applicable third-party liability scenarios.

Key Responsibilities:
  • Oversee subrogation operations, including internal teams and multiple vendor partners managing first-pass and second-pass recovery efforts.
  • Direct the identification, pursuit, and resolution of subrogation cases across a broad spectrum of liability types.
  • Develop and maintain policies, workflows, and escalation protocols to support efficient and compliant subrogation operations across Medicaid, Medicare, and Marketplace populations.
  • Collaborate with legal, claims, provider relations, finance, and compliance departments to ensure coordination and alignment on recovery efforts.
  • Monitor case outcomes and vendor performance to ensure recovery goals are met or exceeded.
  • Conduct regular quality assurance reviews of subrogation case files and provide coaching or corrective action as needed.
  • Analyze trends in recoveries and provide recommendations to improve operational effectiveness and financial performance.
  • Lead training, coaching, and development of subrogation staff to maintain high performance and technical knowledge.
  • Prepare performance dashboards, recovery reports, and operational updates for senior leadership.

Required Qualifications:
  • 5+ years of experience in healthcare subrogation or legal recovery, including direct oversight of multiple subrogation case types.
  • 3+ years of experience in a leadership or management role, including responsibility for both internal staff and vendor oversight.
  • Experience working within a Managed Care Organization (MCO) or health plan environment.
  • Proven ability to manage complex vendor relationships and recovery strategies (e.g., first-pass and second-pass vendor models).
  • Strong understanding of federal and state regulations related to subrogation, including HIPAA, Medicaid TPL requirements, and CMS guidelines.
  • Excellent analytical, negotiation, communication, and team leadership skills.

Preferred Qualifications:
  • Direct experience with subrogation in Medicaid, Medicare, and Marketplace lines of business.
  • Familiarity with QNXT claims processing platform.
  • Knowledge of legal procedures related to complex or litigated subrogation cases.

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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