Long Beach, CA · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Long Beach, CA · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Jacksonville, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Jacksonville, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Long Beach, CA · On-site +1
$45K - $84K/yr
... with contractual and regulatory requirements. • Recommends and implements programs to support ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Long Beach, CA · On-site +1
$45K - $84K/yr
... with contractual and regulatory requirements. • Recommends and implements programs to support ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Orlando, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Orlando, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Long Beach, CA · On-site +1
$96K - $208K/yr
... the QNXT system; collaborates with legal, corporate and other stakeholders as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. • ...
Long Beach, CA · On-site +1
$96K - $208K/yr
... the QNXT system; collaborates with legal, corporate and other stakeholders as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. • ...
Miami, FL · On-site
$100K - $120K/yr
... contractual and regulatory requirements. • Direct benefit configuration and claims system ... g., QNXT, QuickCap, or equivalent) • Strong regulatory knowledge, including CMS, HIPAA, ERISA ...
Miami, FL · On-site
$100K - $120K/yr
... contractual and regulatory requirements. • Direct benefit configuration and claims system ... g., QNXT, QuickCap, or equivalent) • Strong regulatory knowledge, including CMS, HIPAA, ERISA ...
Tampa, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Tampa, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Miami, FL · On-site
$100K - $120K/yr
... with contractual and regulatory requirements. Direct benefit configuration and claims system ... QNXT, QuickCap, or equivalent) Strong regulatory knowledge, including CMS, HIPAA, ERISA, state ...
Miami, FL · On-site
$100K - $120K/yr
... with contractual and regulatory requirements. Direct benefit configuration and claims system ... QNXT, QuickCap, or equivalent) Strong regulatory knowledge, including CMS, HIPAA, ERISA, state ...
Miami, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Miami, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Saint Petersburg, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
Saint Petersburg, FL · Remote
$45K - $84K/yr
Ensures compliance with contractual and regulatory requirements. Recommends and implements programs ... Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
... the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. Oversees plan ...
Ability to price and reprice claims based on contractual agreements * Understanding of provider TIN ... Familiarity with claims adjudication systems (e.g., Facets, QNXT, Amisys, etc.) * Experience with ...
Ability to price and reprice claims based on contractual agreements * Understanding of provider TIN ... Familiarity with claims adjudication systems (e.g., Facets, QNXT, Amisys, etc.) * Experience with ...
... QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. • Oversees plan ...
... QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. • Oversees plan ...
| Aspect | Contractual Qnxt | Contractual Claims Analyst |
|---|---|---|
| Certifications | Qnxt certification, healthcare IT knowledge | Claims processing certifications, healthcare claims knowledge |
| Work Environment | Healthcare IT systems, insurance companies | Insurance companies, healthcare providers |
| Industry Usage | Health insurance administration, IT support | Claims review, reimbursement processing |
Contractual Qnxt professionals focus on managing healthcare insurance systems using Qnxt software, often working in IT or administrative roles. Contractual Claims Analysts primarily handle claims processing and reimbursement tasks within insurance or healthcare organizations. While both roles operate within the healthcare insurance industry, Contractual Qnxt specialists emphasize system management, whereas Claims Analysts focus on claims review and payment processing.
Long Beach, CA • Remote
$45K - $84K/yr
Full-time
Medical
Posted 18 days ago
8.0
Based on 192 frontline employees who took The Breakroom Quiz
147th of 261 rated insurance
JOB DESCRIPTION
Must currently reside in Florida
Job Summary
Leads and supervises team responsible for provision of support center customer service excellence to meet the needs of Molina members and providers. Ensures issues and needs are addressed fairly and effectively, and in alignment with Molina values. Demonstrates accountability for delivery of product and service information, identifies opportunities to improve the member and provider experience, and supports continuous quality improvement initiatives related to member/provider engagement and retention.
Essential Job Duties
Provides leadership and oversight for the member and provider support center; ensures exemplary service is delivered according to Molina goals/objectives/policies/procedures and regulatory requirements, and demonstrates accountability for performance and financial outcomes.
Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
Addresses more complex member inquiries, questions and concerns in all related areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
Provides exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and general public.
Achieves individual performance goals as it relates to call center objectives.
Demonstrates personal responsibility and accountability and leads by example through individual performance.
Ensures compliance with contractual and regulatory requirements.
Recommends and implements programs to support member and provider needs.
Supports projects and special initiatives as appropriate.
Sets a positive example for others and builds the Molina culture by modeling the Molina mission, vision and values in daily actions.
Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
Models dynamic leadership for support center representatives; develops team to focus on delivering great health care/customer service to underserved populations.
Required Qualifications
Bilingual Spanish/English
At least 5 years of customer service, call center and/or sales experience in a fast-paced/high-volume environment, including 3 years of call center experience, or equivalent combination of relevant education and experience.
Strong customer service skills.
Understanding of insurance products including Medicaid, Medicare and Marketplace/enrollment processes.
Organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
Ability to work cross-functionally across a highly matrixed organization.
Strong verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.
Preferred Qualifications
Management/leadership experience.
Systems training/experience for the following : Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing, CVS Caremark, Availity.
Managed care/health care experience.
Broker/health insurance license.
#LI-AC1
#PJCC
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: $45,390 - $84,086 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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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.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
