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Job Information

Molina Healthcare Sr Specialist, Appeals & Grievances in United States

JOB DESCRIPTION

Job Summary

Responsible for oversight regulatory agency complaints and grievances to ensure timely and accurate responses.

KNOWLEDGE/SKILLS/ABILITIES

  • Responsible for submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members and related outside agencies.

  • Researches issues utilizing systems and clinical assessment skills, knowledge and approved “Decision Support Tools” in the decision making process regarding health care services and care provided to members.

  • Responsible for reviewing regulatory agency complaint responses by the Appeals & Grievances team.

  • Created and provided variety of training for staff.

  • Facilitating meetings with Premium Billing as needed

  • Creating and/or updating policy and procedures as needed.

JOB QUALIFICATIONS

Required Education

High School Diploma or GED.

Required Experience

  • Min. 2 years managed care experience.

  • Min. 2+ years of Claims knowledge

  • Familiarity with Medicaid and Marketplace benefits and claim processing.

Required License, Certification, Association

N/A

Preferred Education

Associate's or bachelor’s degree

Preferred License, Certification, Association

N/A

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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