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, Michigan, New Mexico, Missouri, Utah, Ohio, Texas and Washington as well as 19 primary care clinics located in Northern and Southern California. The company's corporate headquarters are in Long Beach, California.

POSITION SUMMARY

The Claims Manager II is accountable for the daily operations of Claims Projects – The manager of this team is responsible for management and oversight of Project Managers and Business Analysts responsible for managing small to large business and system related projects.  The team interfaces with the business units within Claims, IT, other Corporate Departments, and the Health Plans.

PRINCIPLE ACCOUNTABILITIES

• Manages a team of individuals focused on consistently meeting or exceeding established performance targets while demonstrating standards and values of Molina in their interaction with Molina customers, business partners and employees.  Targets can be based upon plans, federal or state requirements as dictated.

• Proactively plans for daily priorities as well as responds to new priorities within the organization and opportunities assigned from upper management.

  Takes part in recruiting activities, including identifying, interviewing internal and external candidates, and selecting those who best fit a high performing, professional, collaborative organization. 

• Develops a high performance, professional, collaborative organization.  Sets high expectations of subordinates and provides coaching, training and feedback to ensure expectations are met.

• Acts as a technical system expert in handling complaints and other escalated issues from external parties (e.g., members, providers, customers (HP, other departments). 

  Participates and supports the development of longer-term strategies to meet business needs.

• Ensure timely processing of units scope of work while maintaining staffing capacity and work product

• Represent Claims Department in internal meetings, e.g. weekly ops calls, outside meetings or facilitation meetings as required

• Accountable for accepting personal responsibility for the quality and timeliness of work assigned and assumes ownership of the results; is versatile and flexible while adapting quickly to change; maintains high work ethics; takes initiative to actively improve performance; collaborates well with all levels of personnel within the company; and provides exemplary customer service.

• Responsible for the management of team resources by reviewing performance and conducting timely performance appraisals acknowledging effort and results; communicates in a clear and concise manner both written and verbally; promotes the importance of being a team player by placing team success ahead of individual success; understands the importance of fiscal responsibility to the organization; is innovative by considering original ideas to address issues, resolve problems, and implement best practices; and is confident in their decision making skills to make spontaneous decisions when required and deductive/methodical decisions where appropriate.

REQUIRED SKILLS AND QUALIFICATIONS

Education:

• Bachelors Degree in Business Related Disciplines, Computer Science, Information Systems or Accounting/Finance

 

Experience:

• 5 to 7 years programming SQL, VB in a windows/client server environment, SQL Server, DTS or equivalent.

• Strong integrated health care systems knowledge, including understanding of data dictionary, core system structure, etc.

• Knowledge of SSIS and SSRS.

• Knowledge of development life cycle.

• Must know MS Access and Excel.

• At least 5 -7 years of related healthcare experience.

• 2-3 years overseeing technical staff.

 

Additional Skills and Knowledge:

• Microsoft Office Programs – Excel, Outlook, PowerPoint, Visio, and Word

•  Excellent interpersonal skills.

• Strong verbal and written communication skills.

• Analytical ability and problem resolution skills.

• Effective time management skills.

• Strong eadership skills.

 

Licensure/Certification:

PMP certification preferred

Claims Projects Team - DEPARTMENT SPECIFIC RESPONSIBILITIES

 

• Manage business related projects for the purpose of improving business processes and efficiencies
• Manage small to large scale projects that may include department SME’s, Configuration, and the Health Plans
• Manage system related projects to include – enhancements, upgrades, conversions, and new applications
• Ensure project management staff is utilizing standard project management methodologies
• Provide oversight to ensure all projects include the appropriate documentation – Project Charter, Business Requirements Document, and Test Plans
• Responsible for managing the annual Business Planning Process to include project estimations
• Maintain vendor relations that support business and systems related processes
• Collaborate with IT to ensure approved projects are managed and executed on schedule
• Serves as the main point of contact for IT – system issues, system downtimes, approval for project deployment
• Responsible for the oversight and maintenance of the department’s Business Continuity Plan

Molina Healthcare offers competitive benefits and compensation package.