Hillsborough County, Florida, United States · On-site
Mid level
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Palm Beach Gardens, Florida, United States · On-site
Mid level$4.3B raised
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Company Description Join Eyeglass World and help lead a team dedicated to delivering quality eye care and clear vision with style. With 100+ stores nationwide, we are known for trendy eyewear, unbeatable value, and same-…
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The Lead, Core Operations manages daily activities including claims processing, provider services, and enrollment to ensure contractual compliance. They also coordinate staff workflows, handle escalations, and lead quality improvement initiatives within the department.
Requirements
Candidates must have at least 4 years of experience in healthcare operations, claims, or provider services. Proficiency in Microsoft Office and knowledge of Medicare, Medicaid, and Marketplace plans are required.
Full job description
JOB DESCRIPTION Job Summary
Provides lead level support for core operations activities including claims processing, benefit interpretation, provider services, provider enrollment, etc., ensuring functional operations and contractual compliance.
Essential Job Duties
• Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
• Performs daily troubleshooting procedures to support enrollment, disenrollment, claims, and claims support functions as needed.
• Coordinates workflow and staffing of day-to-day activities, and assigns and monitors work of staff to adhere to productivity and quality standards.
• Participates in or leads quality improvement efforts to improve claims processes and/or policies.
• Serves as operations subject matter expert, provides training, mentoring and support to team personnel.
Job Requirements
• At least 4 years of health care operations/claims/provider services experience, or equivalent combination of relevant education and experience.
• Customer service experience.
• Knowledge of Medicare, Medicaid, and Marketplace plans.
• Experience supporting a Medicaid or large claims processing environment with multi-functional work units and tasks.
• Organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency.
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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
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.
Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
Offices: 200 Oceangate, Long Beach, California 90802, US
Managed CarePrimary Care ClinicsMedicaidand MedicareHospitalHealth CareManagement Information SystemsMedical
Based on 2986 listings with disclosed salaries, most healthcare jobs in Florida pay between $58k–$149k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in Florida right now?
There are currently 33,476 open healthcare positions in Florida listed on Clera. New openings are added daily as companies post roles.
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Companies currently hiring include University of Miami Health System-Uhealth, Orlando Health, Tampa General Hospital, UF Health, CVS Health, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Florida?
Yes — 2653 of the 33476 open healthcare positions offer remote or hybrid work (1165 remote, 1488 hybrid).
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