Have you ever wanted to be the voice of reason and resolution for people navigating the healthcare maze? At Molina Healthcare, we are looking for a dedicated professional who loves solving complex puzzles and helping others. In this fully remote opportunity that you can do from anywhere in the world, you will step in as a vital bridge between our members, providers, and regulatory standards. If you have a passion for fairness and a knack for thorough investigation, we want you on our team.

Overview

As our Appeals and Grievances Specialist focusing on Medicaid and Marketplace plans, you will take ownership of claims activities and complaints. You will make sure every voice is heard while keeping us fully compliant with state and federal guidelines. This role lets you work independently from your home office while collaborating with a supportive nationwide team.

Key Responsibilities

Investigate and resolve appeals, disputes, and grievances from members and providers while meeting strict regulatory deadlines.
Dive into support systems to research claims and determine the best possible outcomes.
Request and review medical records, clinical notes, and detailed bills to form accurate conclusions.
Apply specific contract language and benefit guidelines to every review process.
Communicate decisions clearly with members and providers through written and verbal channels.
Meet everyday claims production standards set by the department.

Requirements

We need someone who brings strong critical thinking and attention to detail to the table. You should have prior experience in healthcare claims, managed care, or customer advocacy, particularly within Medicaid or Marketplace lines of business. Excellent written and verbal communication skills are a must, along with the ability to navigate multiple computer systems simultaneously while working in a remote environment.

What You'll Gain

Joining Molina means enjoying the ultimate work-life balance with a fully remote schedule that removes your daily commute. You will receive competitive compensation, comprehensive benefits, and continuous opportunities for professional growth in the healthcare sector. Most importantly, you will find daily purpose in making a real difference in the lives of our members.