Claims System Specialist

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 Responsibilities:

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

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

3. Testing of electronic claim submission validation.

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

5. 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.

6. System enhancements testing via claims adjudication.

7. Performs other duties as assigned.

Job Requirements


High School graduate (or GED)/AA preferred. 5 years claims processing with advancement to auditing/claims analysis/claims research. Level of autonomy/decision making required – Mid-level decision making. Some project management skills. Good oral and written communication skills. Advanced Word and Excel 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).