LEAD ANALYST, CONFIGURATION OVERSIGHT (COB/ AUDIT QUALITY & ACCURACY/ CLAIMS CONFIGURATION)
About the role
KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):
Trains audit staff on configuration functionality, enhancements and updates.
Accurately interprets end to end business requirements and able to confirm outcomes meet the specific state/federal requirements.
Creates management reporting tools to enhance audit communication on configurations accuracy results and/or audit findings
Writes complex ad-hoc report
Interprets and validates accuracy of complex MRDT and other configuration update scripts
Assists manager in establishing standards, guidelines, and best practices for the audit team
Interprets and validates accuracy of complex reports and automated configuration processes/solutions
Assist manager in establishing peer review standards and methodolog
Leads peer reviews
Research and review new audit tools and techniques and provide recommendations to management
Validates accuracy of new complex configuration processes/solutions
Verifies accuracy of MRDT, fee schedule, premium, AutoQ, and other file load packages
Interprets complex business problems and technical issues
Effectively communicates audit findings and/or outcomes through review meetings, written communications, and, workflow diagrams.
Helps drive solution to successful implementation by directing technical and business resources during all phases of the software development life cycle
Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment
Develops and maintain standards and best practices for the team
Mentors junior auditors
Participates in or leads project meetings
Understands QNXT, AutoQ, and MCG functionality and schema
Writes Requirements for BRDs/FRDs and Reports without needing mentoring
Suggests schema/solution. Works with technical resource to determine best solution.
Manages complex projects from requirements to deployment, including work assignment, prioritization, issue triage etc.
Researches complex issues\\
Acts as a team lead, assigning and prioritizing work for other team members as needed
JOB FUNCTION:
Responsible for accurate and timely auditing of critical information on claims databases.
Maintains critical auditing and outcome information. Synchronizes data among operational and claims systems and application of business rules as they apply to each database.
Validate accuracy of configuration and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
Responsible for work load assignment to auditors.
Train and coach new employees .
Provide clear and concise results and comments to leaders about focal and and random audits across all states.
Monitors and controls workflow.
Ensures that audits are conducted in a timely fashion and in accordance with unit standards.
REQUIRED EDUCATION:
Bachelor’s Degree or equivalent combination of education and experience
REQUIRED EXPERIENCE:
5-6 Years
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
PREFERRED EDUCATION:
Graduate Degree or equivalent experience
PREFERRED EXPERIENCE:
7+ Years
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
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: $59,810.6 - $129,589.63 / ANNUAL
\*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Remote positions are U.S.-based only. Candidates must reside and be authorized to work in the United States.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type Full Time
Posting Date 09/14/2026
Minimum requirements
- Bachelor’s degree or equivalent and 5-6 years of relevant experience
- Proficient in auditing claims databases, configuration validation, and complex report writing
- Strong leadership skills with ability to train staff, manage projects, and communicate audit findings effectively
This listing was parsed by AI and may not be complete. Check the official posting on Molina Healthcare's site for the most accurate information.