Molina Healthcare jobs in Kettering, OH

Job DescriptionJob SummaryInterfaces with internal and external customers in reviewing scope and developing requirements and plans for testing / quality assurance for enterprise projects of considerable complexity. Works with cross functional teams to prepare comprehensive test design specifications for functional, regression, performance and security testing. Performs analysis to identify...

JOB DESCRIPTION Job SummaryProvides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member...

JOB DESCRIPTION Job SummaryProvides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS).Essential Job Duties- Facilitates comprehensive research and resolution of...

Job DescriptionJob SummaryResponsible for all the aspects of architecture, design and implementation of Data Management solution using Big Data platform on Cloudera or Hortonworks and other areas of enterprise application platforms.Knowledge/Skills/Abilities- Convert concepts to technical architecture, design and implementation- Provide guidance on choosing ideal Architecture, Evaluating tools...

Job DescriptionJob SummaryThe Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.Knowledge/Skills/Abilities+ Facilitates the resolution of...

JOB DESCRIPTION Job SummaryProvides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care.Essential Job Duties- Engages with members as...

JOB DESCRIPTION Job SummaryProvides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care.Essential Job Duties- Engages with members as...

JOB DESCRIPTION Job SummaryProvides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care.Essential Job Duties- Engages with members as...

JOB DESCRIPTION Job SummaryProvides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care.Essential Job Duties- Engages with members as...

JOB DESCRIPTION Job SummaryProvides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS).Essential Job Duties- Facilitates comprehensive research and resolution of...

Job DescriptionJob SummaryRespond to inbound calls to provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.Knowledge/Skills/Abilities+ Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents...

Job DescriptionJob SummaryAs the Manager, Protection Services Operations Center (PSOC), you will be a member of Molina Healthcare's Protection Services Operations Center, reporting to the Director. This role is crisis and threat intelligence focused and includes responsibilities for ensuring the execution of the physical security controls, threat/risk analytics, and incident intake and crisis...

JOB SUMMARY - Lead Data EngineerA Lead Data Engineer collaborates with the Data Quality and Governance team to ensure data pipelines, data integrity, and compliance by defining data strategies, implementing Data Governance capabilities, creating self-service data assets, and integrating robust data quality and governance frameworks to support trustworthy AI solutions. Key responsibilities include...

JOB DESCRIPTION Job SummaryProvides analyst support for actuarial function activities including extracting, analyzing, and synthesizing data from various sources to identify risks. Estimates liabilities, establishes premium rates, and supports financial analysis and reporting.Essential Job Duties- Collaborates with actuarial team to complete incurred but not reported (IBNR) estimates and rate...

Job DescriptionJob SummaryThis position will be responsible for supporting the execution of merger and acquisition transactions and will actively contribute in advancing Molina Healthcare's overall growth strategy. The role entails working closely with the senior members of the Corporate Development team and will actively interact with the business leaders and senior management team at Molina.The...

JOB DESCRIPTIONJob SummaryDesigns and builds company specific enterprise application systems and technology expertise across multiple disciplines.Applies and promotes key principles (e.g., stability, scalability, performance, security, compatibility, re-use), helping ensure a balance between tactical and strategic technology solutions. Considers business problems "end-to-end": including people,...

Job DescriptionWork hours will be 7am-3:30pm PST M-FJob SummaryResponsible for conducting various healthcare Healthcare claim audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to...

JOB DESCRIPTION Job Summary The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining...

JOB DESCRIPTIONJob SummaryProvides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.Essential Job Duties- Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective...

JOB DESCRIPTIONJob Summary+ Provides customer support and stellar service to meet the needs of our Molina members and providers.+ Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions.+ Provides product and service information and identifies opportunities to improve our member and provider experiences.KNOWLEDGE/SKILLS/ABILITIES+ Supervises...