Job Summary We are looking for a highly experienced Lead Configuration Analyst to enhance our Payment Integrity and Claims Operations teams. Your primary responsibility will be to ensure the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. Key Responsibilities: Review Medicaid COB claims for correct secondary pricing logic and adherence to configuration and regulatory requirements. Analyze claim outcomes to identify trends or discrepancies, particularly regarding over- or underpayments. Utilize QNXT to research claims history and configuration. Collaborate cross-functionally to resolve identified issues with Configuration, Claims, and Payment Integrity teams. Support audits, validations, and root cause analysis associated with COB and TPL processing logic. Contribute to developing internal SOPs and audit tools for COB claim reviews. Act as a subject matter expert for Medicaid COB claim adjudication and configuration testing. Provide training and mentorship to junior analysts as required. Use SQL to extract and analyze data effectively. Interpret complex business requirements, ensuring compliance with state and federal guidelines. Assist management in setting standards and best practices for audits. Validate the accuracy of new complex configuration processes/solutions. Communicate findings effectively through meetings, written reports, and diagrams. Participate in or lead project meetings, managing projects from requirements to deployment. Research and resolve complex issues related to claims. Qualifications: Required Education: Associate's Degree or equivalent combination of education and experience. Required Experience: 5+ years in oversight, auditing, and operations with a strong understanding of QNXT claims processes. Proficient in Microsoft Office applications (Excel, Word, PowerPoint, Outlook, Teams). Exceptional written and verbal communication skills. Flexible and committed to high quality, timely delivery. Previous experience in process improvement and mentoring peers is essential. Preferred Qualifications: Bachelor's Degree or equivalent experience. Experience in Payment Integrity and/or COB/Claims roles within a health plan or vendor. Familiarity with claim recovery audits and Medicaid regulatory requirements. Exposure to EDI transactions and COB data exchange protocols. Experience with SQL is a plus. Physical Demands: The working environment is generally favorable with adequate lighting and temperature control. The position requires sitting for extended periods. Reasonable accommodations may be provided for individuals with disabilities. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package, and is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $155,508 annually (compensation may vary based on location, experience, and education).