Long Beach, California, United States · Remote Solely
JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance wit…
Skills: Appeals and grievances, Claims processing, Managed care, Medicare, Medicaid
Long Beach, California, United States · On-site
$190k–$220k/yr
ABOUT ROCKET LAB Rocket Lab is the end-to-end space company building rockets, spacecraft, and critical subsystems that keep the world connected, protected, expand humanity’s reach to the Moon, Mars, and beyond. We move f…
Skills: Financial planning, Financial analysis, Cost management, Capital investment, Manufacturing finance
Long Beach, California, United States · Remote OK
JOB DESCRIPTION Job Summary Responsible for leading the strategic development, governance, implementation, maintenance, and optimization of the organization's post-pay payment integrity concept portfolio. This role leads…
Skills: Payment integrity, Claims processing, Strategic planning, Team leadership, Business analysis
Long Beach, California, United States · On-site
$33/hr–$49/hr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Composites manufacturing, Carbon fiber layup, Fiberglass layup, Vacuum bagging, Laser projection systems
Long Beach, California, United States · On-site
$102k–$156k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Manufacturing engineering, Fluid systems, Mechanical assembly, Tooling design, Design for manufacturability
Coyne & Associates Education Corp.Long Beach, California, United States · Hybrid
$88k–$95k/yr
**Any applicants without a current Board Certified Behavior Analyst (BCBA) Certification will NOT be considered** Hybrid Role - UP TO 60% REMOTE SUPERVISION Ready to change lives from your couch (or wherever you like) wh…
Skills: Board Certified Behavior Analyst, ABA therapy, Supervision, Clinical supervision, Team management
Long Beach, California, United States · On-site
$160k–$240k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Fluid system architecture, Systems engineering, Thermodynamics, Fluid dynamics, Heat transfer
Long Beach, California, United States · On-site
$130k–$194k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Industrial maintenance, Equipment reliability, Manufacturing operations, Team leadership, Troubleshooting
Long Beach, California, United States · On-site
$104k–$156k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Manufacturing engineering, Combustion device manufacturing, Process development, Work instructions, Design for manufacturing
Long Beach, California, United States · On-site
$109k–$163k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Propulsion integration, Test engineering, Hardware assembly, Process development, Production support
Long Beach, California, United States · Hybrid
$181k–$271k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Agentic infrastructure, Linux, MacOS, Networking, LLM inference
Long Beach, California, United States · Hybrid
$154k–$230k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Agentic infrastructure, Linux, MacOS, Networking, Automation
Long Beach, California, United States · On-site
$164k–$246k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Test engineering, Hardware-in-the-loop (HITL), Test automation, CI/CD pipelines, Embedded systems
Long Beach, California, United States · On-site
$151k–$227k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Battery testing, High-voltage systems, Test strategy, Failure analysis, Data systems
Long Beach, California, United States · On-site
$33/hr–$50/hr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Cryogenic systems, Pneumatic systems, Hydraulic systems, Rocket testing, Data control systems
Long Beach, California, United States · On-site
$27/hr–$40/hr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Aerospace Testing, Fabrication, Troubleshooting, Calibration, Inspection
Long Beach, California, United States · On-site
$33/hr–$50/hr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Cryogenic Systems, Pneumatic Systems, Hydraulic Systems, Data Control Systems, Hazard Mitigation
Long Beach, California, United States · On-site
$104k–$156k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Hardware integration, Manufacturing engineering, Root cause analysis, GD&T, CAD
Long Beach, California, United States · On-site
$104k–$143k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: GD&T, CAD, Root Cause Analysis, Tolerance Stack-up Analysis, Structural Proof Testing
Long Beach, California, United States · On-site
$112k–$143k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Pneumatic Systems, Electrical Systems, Mechanical Systems, Test Procedure Authoring, Root Cause Analysis
Long Beach, California, United States • Remote Solely
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Facilitate the research and resolution of member and provider appeals, grievances, and complaints in accordance with CMS standards. Ensure all responses are accurate, timely, and compliant with state and federal regulatory guidelines.
Requires at least 2 years of experience in managed care, specifically within call center, appeals, or claims environments. Candidates must possess strong knowledge of Medicare and Medicaid claims processing and regulatory guidelines.
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS).
Essential Job Duties
• Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met.
• Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes.
• Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines.
• Meets claims production standards set by the department.
• Applies contract language, benefits and review of covered services to claims review process.
• Contacts members/providers as needed via written and verbal communications.
• Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested).
• Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements.
• Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors.
• Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies.
Required Qualifications
• At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience.
• Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria.
• Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials.
• Customer service experience.
• Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Effective verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
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
