Molina Healthcare Inc. Logo

Molina Healthcare Inc.

Director, Configuration (EDI & Inbound Claims)

Posted 2 Months Ago
Be an Early Applicant
Remote
Hiring Remotely in United States
Senior level
Remote
Hiring Remotely in United States
Senior level
Lead a configuration/product team delivering and maintaining enterprise configuration and claims solutions. Own product vision, backlog, and delivery; partner with stakeholders, engineering, QA, compliance, and health plans to ensure scalable, compliant solutions and operational efficiency.
The summary above was generated by AI

***Remote and must live in the United States***

JOB DESCRIPTION 

Job Summary

Leads and directs team responsible for the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations. Leads the product vision, backlog, and delivery outcomes and serves as the primary bridge between business stakeholders and technical delivery teams. Ensures solutions align to business outcomes, regulatory requirements, and enterprise strategy, while partnering closely with engineering, architecture, data, QA, and operations teams on how solutions are delivered.
 

Job Duties

  • Directs configuration team and demonstrates accountability for team performance - including meeting or exceeding established performance targets; targets may be based upon specific health plan requirements, and/or federal/state requirements. 
  • Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals
  • Coordinates activities of assigned work function and/or department related activities ensuring efficiency and prioritization.
  • Strategically plans, leads, and manages configuration workflow processes.
  • Continuously identifies and executes opportunities for operational efficiencies and develops best practice approaches for assigned operational areas, ensuring achievement of organizational/department goals.
  • Identifies appropriate resources are available to achieve department goals - escalates resource needs, rationale, and deficiencies to leadership.
  • Ensures appropriate follow-up and communication occurs on direct assignments, and activities and tasks that fall within the scope of configuration.
  • Ensures team compliance with applicable federal/state regulations and internal policies/procedures.
  • Owns and communicates a clear product vision aligned to enterprise strategy and operational outcomes.
  • Partners with business stakeholders to understand problems, desired outcomes, constraints, and regulatory obligations.
  • Directs the development and implementation of contract, benefit configuration, and fee schedules.
  • Directs the implementation and maintenance of member benefits in the claims payment system and other applicable systems.
  • Supports critical business strategies by providing systematic solutions and/or recommendations on business processes.
  • Plans for long-term success of the department and individual health plans - focusing on goals and improvements to daily operations.
  • Builds and maintains strong trusted relationships with key stakeholders including health plan leadership and other cross-functional departments; presents data and opportunities to stakeholders and collaborates on performance improvement initiatives. 
  • Collaborates closely with engineering, architecture, data, QA, operations teams, and Health Plans to ensure solutions are feasible, scalable, and supportable.
  • Partners with health plan, compliance, legal, and audit teams as needed to support reviews and implementations.
  • Supports enterprise goals related to standardization and reduction of unmanaged complexity.
  • Partners closely with stakeholders to clarify requirements and translate needs into backlog items.

Job Qualifications

REQUIRED QUALIFICATIONS:

  • At least 8 years of experience in product ownership, product management, business analysis, or technical solution delivery.
  • At least 3 years of management/leadership experience.
  • Demonstrated experience working within Agile/Scrum delivery models.
  • Experience supporting technical products such as enterprise platforms, configuration tools, data solutions, integrations, or operational systems.
  • Strong understanding of software development lifecycles and Agile principles.
  • Proven ability to write clear, testable user stories and acceptance criteria.
  • Experience prioritizing work in complex, highly regulated environments.
  • Strong analytical and problem‑solving skills.
  • Excellent communication skills with the ability to influence across technical and non‑technical audiences.
  • Ability to operate effectively in ambiguity and make decisions with incomplete information.

PREFERRED QUALIFICATIONS:

  • Prior Product Owner or Product Manager certification strongly preferred at time of hire.
  • Experience with enterprise platforms, APIs, integrations, or configuration‑heavy systems.
  • Experience in healthcare, financial services, or other regulated industries.
  • Familiarity with Agile tooling (e.g., Jira, Azure DevOps, Rally).
  • Developing and writing SQL queries
     

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

HQ

Molina Healthcare Inc. Long Beach, California, USA Office

Long Beach, CA, United States

Molina Healthcare Inc. Los Angeles, California, USA Office

Los Angeles, United States

Molina Healthcare Inc. Pomona, California, USA Office

Pomona, United States

Similar Jobs

5 Minutes Ago
Remote or Hybrid
85K-105K Annually
Senior level
85K-105K Annually
Senior level
eCommerce • Real Estate • PropTech
The Senior Accountant leads day-to-day accounting operations, including general ledger, financial close, reconciliations, accounts payable, and accounts receivable. The role directly manages AP and AR teams, oversees invoicing, collections, vendor payments, and controls, and partners with the Controller on reporting and audits. It also focuses on process improvement, workflow automation, documentation, team development, and building scalable accounting operations.
Top Skills: Accounting System IntegrationsErp/Accounting SystemsExcelWorkflow Automation Tools
9 Minutes Ago
Remote or Hybrid
Expert/Leader
Expert/Leader
Cloud • Computer Vision • Information Technology • Sales • Security • Cybersecurity
Leads CrowdStrike’s national channel sales relationship with CDW, overseeing alliance managers, developing strategic growth plans, aligning executive and sales teams, and driving partner-sourced revenue. The role requires deep CDW knowledge, executive relationships, enterprise go-to-market experience, negotiation skills, leadership, and the ability to use AI technologies to improve business outcomes.
Top Skills: AICybersecurityNetworking Technologies
10 Minutes Ago
Remote or Hybrid
USA
68K-75K Annually
Junior
68K-75K Annually
Junior
Fintech • Healthtech • HR Tech • Information Technology • Financial Services • Telehealth
Leads Care Managers and Care Specialists, ensuring high-quality, consistent user support. Responsibilities include setting expectations, coaching, reviewing call and chat quality, managing escalations, analyzing performance data, improving workflows, supporting training and onboarding, and representing frontline needs cross-functionally. The role also handles select complex user cases and promotes a culture of empathy, accountability, inclusion, and continuous improvement.

What you need to know about the Los Angeles Tech Scene

Los Angeles is a global leader in entertainment, so it’s no surprise that many of the biggest players in streaming, digital media and game development call the city home. But the city boasts plenty of non-entertainment innovation as well, with tech companies spanning verticals like AI, fintech, e-commerce and biotech. With major universities like Caltech, UCLA, USC and the nearby UC Irvine, the city has a steady supply of top-flight tech and engineering talent — not counting the graduates flocking to Los Angeles from across the world to enjoy its beaches, culture and year-round temperate climate.

Key Facts About Los Angeles Tech

  • Number of Tech Workers: 375,800; 5.5% of overall workforce (2024 CompTIA survey)
  • Major Tech Employers: Snap, Netflix, SpaceX, Disney, Google
  • Key Industries: Artificial intelligence, adtech, media, software, game development
  • Funding Landscape: $11.6 billion in venture capital funding in 2024 (Pitchbook)
  • Notable Investors: Strong Ventures, Fifth Wall, Upfront Ventures, Mucker Capital, Kittyhawk Ventures
  • Research Centers and Universities: California Institute of Technology, UCLA, University of Southern California, UC Irvine, Pepperdine, California Institute for Immunology and Immunotherapy, Center for Quantum Science and Engineering

Sign up now Access later

Create Free Account

Please log in or sign up to report this job.

Create Free Account