Sr. Specialist, Delegation Oversight/Claims Auditor
Company: Molina Healthcare
Location: Long Beach
Posted on: June 12, 2021
Responsible for continuous quality improvements within the
Delegation Oversight Department. Oversees delegated activities to
ensure compliance primarily with DMHC and DHCS requirements
including delegation standards and requirements contained in the
Molina Medical Compliance and Fraud, Waste and Abuse Program.
Claims Audit experience is highly desirable.
KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational
knowledge and specific technical and professional skills and
abilities required to perform the essential duties of this
- Coordinates, conducts, and documents delegation assessments as
necessary to comply with state, federal, NCQA, and any other
- Prepares status reports from Delegated Entities. Develops
corrective action plans when deficiencies are identified, and
documents follow-up to completion. Ensures compliance with
reporting requirements by tracking the receipt and completeness of
- Develops corrective action plans when compliance issues are
identified, and document follow-up to completion.
- Assists with meetings of the Delegation Oversight Committee,
including the preparation of documents for committee oversight of
- Works with Network Management team to develop and maintain
delegation agreements and assessment tools.
- Prepares delegation oversight document evidence for state
monitoring visits and NCQA accreditation surveys and participates
on Molina's work team.
Bachelor's Degree or equivalent combination of education and
- 3+ years managed care experience.
- Min. 1 year experience completing delegation oversight
- Data analysis experience.
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
Valid State Driver's License
Bachelor's Degree in Business or Health Care related field.
- 5 years managed care experience.
- 2 years experience completing delegation oversight
- Quality management/regulatory experience with increasing
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Working environment is generally favorable and lighting and
temperature are adequate. Work is generally performed in an office
environment in which there is only minimal exposure to unpleasant
and/or hazardous working conditions. Must have the ability to sit
for long periods. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential
Molina Healthcare is a nationwide fortune 500 organization with
a mission to provide quality healthcare to people receiving
government assistance. If you are seeking a meaningful opportunity
in a team-oriented environment, come be a part of a highly engaged
workforce dedicated to our mission. Bring your passion and talents
and together we can make a difference in the lives of others.
Molina Healthcare offers a competitive benefits and compensation
package. Molina Healthcare is an Equal Opportunity Employer (EOE)
Keywords: Molina Healthcare, Long Beach , Sr. Specialist, Delegation Oversight/Claims Auditor, Other , Long Beach, California
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