Molina Healthcare Sr Specialist, Appeals & Grievances in United States
Responsible for oversight regulatory agency complaints and grievances to ensure timely and accurate responses.
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.
High School Diploma or GED.
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
Associate's or bachelor’s degree
Preferred License, Certification, Association
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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