Teams at Molina Healthcare Inc.

Examines complex healthcare claims to identify coding errors, fraud, abuse, waste, overpayments, and processing defects. Manages claim caseloads, obtains medical records, monitors claimant treatment, recommends investigations and resolutions, ensures regulatory compliance, and supports claims process improvement initiatives while meeting quality and production standards.

Supports vulnerable members with navigating health care benefits, scheduling appointments, arranging transportation, obtaining prescriptions, and accessing social services. Conducts outreach through phone and field visits to homes, shelters, nursing homes, and provider offices. Helps members maintain Medicaid eligibility, researches hard-to-reach members, and collaborates with health care teams. The role requires local travel, strong communication and organizational skills, reliable transportation, and at least one year of health care experience.

Supports Wisconsin IRIS participants with long-term care planning, community resources, budgets, documentation, compliance, and self-directed services. Builds trusting relationships, conducts participant visits, coordinates providers and fiscal agencies, develops individualized plans, monitors outcomes, and helps participants navigate employment, housing, health, safety, transportation, and community goals. The role is remote but requires regular community visits, in-person team meetings, and travel throughout the service area.