Program Manager (Claims - MST hours)

Reposted 13 Hours Ago
Be an Early Applicant
6 Locations
In-Office or Remote
Mid level
Insurance
The Role
Manage claims program governance, policies, workflows, controls, budgets and vendor practices. Drive portfolio/initiative change, create requirement/test/training documentation, track metrics, coordinate governance meetings, and recommend program enhancements to improve adoption and value realization.
Summary Generated by Built In

JOB DESCRIPTION

Job Summary

Provides support to Molina functional areas (Claims, and claims configuration) 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. 


Job Duties

  • Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective claims & claims configuration 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.

JOB QUALIFICATIONS

REQUIRED QUALIFICATIONS:

  • 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.

PREFERRED QUALIFICATIONS:

  • Clams & claims configuration experience.
  • QNXT
  • Provider Relations

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 4 years of Program and/or Project management 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
  • Claims & claims configuration experience
  • QNXT
  • Provider Relations
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The Company

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.

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