Program Manager (Claims Research)

Molina Healthcare•Long Beach, CA

About The Position

Provides support to the Claims Research Team, offering expert-level guidance, mentorship, and training to Analyst's and Sr Analyst's through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable.

Requirements

At least 4 years of Program and/or Project management experience, or equivalent combination of relevant education and experience.
Operational Process Improvement experience.
Managed Care experience, preferably in a shared service, CoE or matrixed environment.
Experience with Microsoft Project and Visio.
Strong presentation and communication skills.

Nice To Haves

7+ years experience in medical claims processing, research, or a related field.
Extensive knowledge of medical billing codes (CPT, ICD-10, HCPCS) and claims adjudication process.
Experience supporting or leading regulatory compliance audits.

Responsibilities

Lead and manage the resolution of the most complex and high-impact claims projects, including root cause analysis and remediation planning.
Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program.
Manages program budget, as applicable, supporting project prioritization.
Collaborates with Legal, Compliance, and Information Security to ensure governance standards are upheld.
Tracks performance metrics and ensures value realization from deployed solutions.
Coordinates recurring meetings to support governance framework and decision-making processes, as needed.
At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management.
Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral.
Routinely reviews program collateral to ensure current and accurate reflection of business needs.
Identifies opportunities/gaps and provides recommendations on program enhancements to respective leadership team.
Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
Generates and distributes standard reports on schedule.