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Lead Analyst, Payment Integrity - Health Plan (Remote)

May 23, 2026

JOB DESCRIPTION Job Summary Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance. Essential Job Duties <ul><li>Business Leadership & Operational Ownership</li><li> Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.</li><li> Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.</li><li> Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight.</li><li> Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.</li><li> Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.</li><li> Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries.</li><li>Analyze data to identify and develop new recovery opportunities</li><ul><li>Analyze data from Payment Integrity and Vendors against contracts, billing, and processing guidelines</li><li>Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.</li><li>Conduct peer reviews of recovery concepts and offer recommendations for logical improvements; assist team members in their analysis of data sets and trends.</li></ul><li>Responsible for documenting policies and procedures related to concept approvals</li><ul><li>Conduct trainings and prepare training documentation for teams</li><li>Other duties as assigned </li></ul></ul>Strategic Business Analysis <ul><li> Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.</li><li> Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.</li><li> Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.</li><li> Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets.</li><li>Applied Analytical Support</li><li> Uses data analysis tools/systems to support business analysis.</li><li> Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.</li><li> Creates succinct summaries and visualizations that enable faster leadership decision-making. </li></ul>Required Qualifications <ul><li> At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.</li><li> Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.</li><li> Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.</li><li> Strong data analysis/queries experience, and ability to analyze data to inform business decisions.</li><li> Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.</li><li> Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.</li><li> Strong written and verbal communication skills, including ability to synthesize complex information.</li><li> Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.</li><li>Claims processing background</li><li>Experience with Medicare, Medicaid, and/or Marketplace lines of business.</li><li>Payment integrity (PI) programs </li></ul>Preferred Qualifications <ul><li> Experience with Medicare, Medicaid, and/or Marketplace lines of business.</li><li> Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.</li><li> Project management experience.</li><li> Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence. </li></ul>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 Pay Range: $63,133 - $129,589.63 / ANNUAL <ul><li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li></ul>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...