JOB DESCRIPTION
Job Summary
Leads and manages team responsible for operations activities including Marketplace enrollment execution, reconciliation accuracy, and regulatory compliance within Marketplace Enrollment Operations etc., ensuring functional operations, contractual compliance, and alignment with member satisfaction, retention, quality, and financial goals.
Essential Job Duties
• Oversees performance and financial results of designated operational units.
• Serves as primary point of contact for all matters related to operational units, and achievement of service level agreements (SLAs) and other contractual requirements under assigned areas of supervision.
• Develops budget inputs for areas of responsibility.
• Attends/facilitates meetings as appropriate for day-to-day activities/responsibilities of operational units.
• In conjunction with leadership, establishes performance goals to support overall operational unit objectives.
• Establishes and maintains excellent relationships with internal and external stakeholders.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
Job Requirements
• At least 7 years of health care operations/claims/provider services experience, or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Strong customer service experience.
• Knowledge of Medicare, Medicaid, and Marketplace plans.
• Experience supporting a Medicaid or experience in a large claims processing environment with multi-functional work units and tasks.
• Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively across a highly matrixed organizationm and establish and maintain effective relationships with internal and external stakeholders.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency (including Excel), and applicable software programs proficiency.
Preferred Experience
- 834 Enrollment File Processing
- Enrollment Reconciliation
- SOX Compliance & Audit Support
- Vendor Management
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
Skills Required
- At least 7 years of health care operations, claims, or provider services experience
- At least 1 year of management or leadership experience
- Strong customer service experience
- Knowledge of Medicare, Medicaid, and Marketplace plans
- Experience supporting Medicaid or in a large claims processing environment with multi-functional work units
- Strong organizational and time-management skills; ability to manage simultaneous projects and meet deadlines
- Ability to work cross-collaboratively across a highly matrixed organization and maintain effective stakeholder relationships
- Strong verbal and written communication skills
- Proficiency with Microsoft Office suite (including Excel) and applicable software programs
What We Do
Molina Healthcare Inc. is dedicated to delivering effective, reliable, and affordable health care to those who need it most. The company focuses on improving the health and well-being of its members and positively impacting the communities it serves. Recognized as a leader in the health insurance category, it provides essential healthcare services to ensure accessible and quality care for its members.
