Teams at Molina Healthcare Inc.

Provides administrative, telephone, and data-entry support for coordination of benefits activities. Validates insurance information through carrier portals, updates other-insurance records and COB databases, and coordinates with CMS or internal contacts regarding Medicare premium restoration and related issues. The role requires healthcare administrative experience, attention to detail, customer service, communication, organizational skills, and proficiency with Microsoft Office.

Leads federal and state government affairs, policy advocacy, lobbying, legislative monitoring, regulatory strategy, and PAC contribution activities. Builds relationships with Congress, government agencies, state health plans, and other stakeholders; advises senior leadership; coordinates lobbyists; and may manage policy professionals. Requires extensive knowledge of Medicaid, Medicare, Marketplace programs, healthcare policy, ACA issues, state legislative processes, and government relations.

Reviews and resolves member and provider appeals, grievances, disputes, and claims reconsiderations. Researches medical records, claims, contracts, benefits, fee schedules, and payment errors to determine appropriate outcomes. Prepares compliant correspondence and appeal summaries, communicates decisions, documents findings, and meets regulatory and production timelines for Medicare, Medicaid, and other managed care programs.