JOB DESCRIPTION 

Responsible for timely intake and accurate interpretation of regulatory requirements related to benefit coverage, service reimbursement, and processing of a claim to support system solutions development and maintenance for claim payment. This role includes coordination with stakeholders and subject matter experts on partner teams and support of governance committees where applicable.

DUTIES AND RESPONSIBILITIES

Develops and maintains requirement documents related to coverage, reimbursement and other applicable claim adjudication areas to ensure alignment to regulatory baseline requirements and any health plan developed requirementsMonitors regulatory sources to ensure all updates to products and payment are in alignment with contractual baselinesCommunicates requirement interpretations and changes to health plans and various impacted corporate core functional areas for coverage and payment requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practicesProvide support for claim and/or requirement interpretation inconsistencies and inquiriesSelf-organized reporting to ensure health plans and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financialsMaintains tickets and work tracking toolsMaintains relationships with Health Plans and Corporate teams to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning  

KNOWLEDGE, SKILLS AND ABILITIES

Policy/government legislative review knowledgeStrong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the companyAbility to concisely synthesize large and complex requirementsAbility to organize and maintain regulatory data including real-time policy changesSelf-motivated and able to take initiative, identify, communicate, and resolve potential problemsAbility to work independently in a remote environmentAbility to work with those in other time zones than your ownAbility to maintain requirements for multiple States

Required Experience

2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent fieldStrong analytical and problem-solving skillsRobust knowledge of Office Product Suite including Word, Excel including pivot tables and VLOOKUP's, Outlook and Teams

Preferred Experience

Minimum Bachelor's Degree or equivalent experience; preferred focus of study in public health, public policy related to insurance and managed care or businessPrevious success in a dynamic and autonomous work environmentProject implementation experienceKnowledge and experience with federal regulatory policy resources including CMS and the Affordable Care ActFamiliarity with claim administration systemsFamiliarity or interest in adoption of AI work tools including Microsoft Copilot

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: $49,430.25 - $107,098.87 / 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.

Job Type Full Time Posting Date 02/10/2026