Claims Manager

Molina Healthcare Inc., is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare—including individuals covered under Medicaid, the Healthy Families Program, the State Children’s Health Insurance Program (SCHIP) and other government-sponsored health insurance programs. Molina has health plans in California, Indiana, Michigan, New Mexico, Utah and Washington as well as 21 primary care clinics located in Northern and Southern California with future plans in Ohio and Texas. The company’s corporate headquarters are in Long Beach, California.

Job Overview

Under the general direction of the Director Claims Services, the Claims Manager is accountable for the daily operations of Claims system testing, to include but not limited to:

1. Oversight of testing of contract configuration via claims processing for new and existing Molina Health Plans.

2. Oversight of testing of benefit configuration via claims processing for new and existing Molina Health Plans.

3. Oversight of testing of electronic claim submission validation.

4. Oversight of testing accuracy of system computation upon implementation or creation of fee schedules for new and existing Molina Health Plans.

5. Works collaboratively with Configuration, IT and other Mgmt in creating / carrying out testing plans and communicating results.

6. Report testing for new and revised reports used with Claims and used as a means of workflow with other Molina Healthcare departments and/or plans.

7. System enhancements testing via claims adjudication.

8. Complies with performance standards.

9. The Claims Manager will ensure that the staff are properly trained and effectively managed.

10. All documentation related to testing is maintained in a SOX compliant manner.

11. Reviews performance of staff, counsel, train, and assist staff.

12. Performs other duties as assigned.

Job Requirements


College Degree or equivalent work experience. 8 to 10 years claims processing with advancement to claims supervisory position. Prior supervisor experience. High level decision making skills. Project management skills. Excellent oral and written communication skills. Advanced Microsoft Office skills. Familiarity with multiple claims payment systems – with QCSI knowledge/experience a plus

Molina Healthcare offers competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE).