Role Description We are seeking a detail-oriented SIU Investigator to join our team. In this role, you will play a crucial role in ensuring the accuracy, compliance, and integrity of healthcare claims through comprehensive audits, analyses, and process improvements. The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change in aberrant behavior observed in our healthcare customer's claims and enrollment data. You will work both independently and with a team of clinical SMEs to analyze data, assess exposure, and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting for FWA recoupments and savings. Qualifications - Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies. - Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field. - Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity. - Experience handling confidential information and following policies, rules, and regulations. - Experience with commercial, Medicare, or Medicaid claims is highly preferred. - Strong analytical and problem-solving skills, with attention to detail and accuracy. - Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers. - Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software is a plus. Requirements - Identify and conduct investigations into known or suspected FWA with high autonomy. - Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. - Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity). - Participate in the development and presentation of FWA-related education for assigned Customers. - Perform coding reviews for flagged claims, to support Coding team (if applicable). Preferred Qualifications - Certifications: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP), or similar desired. - Additional Certifications: Certified Professional Coder (CPC) or similar desired.

• Working closely with clients to understand strategic objectives, operational challenges and implementation requirements • Translating client needs into clearly defined deliverables for engineering and product teams • Supporting implementation planning, including milestones, timelines and stakeholder updates • Acting as a key point of contact throughout the client implementation lifecycle • Managing and triaging technical issues, feedback and readiness activities during deployment • Supporting testing and quality assurance activities to ensure successful solution delivery • Providing post-implementation support during agreed support periods and peak delivery phases • Collaborating cross-functionally with Product, Engineering, Account Management and Customer teams to ensure successful outcomes

• Play a critical role in supporting, enhancing, and optimising our Workday HCM landscape. • Work across Core HCM modules and Integrations, partner closely with People Team, Payroll and IT stakeholders. • Ensure our Workday environment remains accurate, compliant, and scalable. • Translate business needs into robust Workday solutions while driving a seamless and intuitive user experience. • Maintain and troubleshoot existing Workday integrations, ensuring accuracy, stability, and timely issue resolution. • Support the design, testing, and deployment of new integrations. • Lead the design, configuration, and maintenance of Core HCM foundation elements. • Build and optimize complex Business Processes (BPs). • Serve as the primary owner for Tier 1 and Tier 2 support tickets. • Manage mass data updates in Workday via EIBs. • Conduct regular system health checks, audits, and root-cause analysis. • Act as the primary administrator and subject matter expert for the Workday Absence module. • Manage absence plans and configurations.

Role Description Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance. Qualifications - At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience. - Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity. - Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules. - Strong data analysis/queries experience, and ability to analyze data to inform business decisions. - Strong business judgment, cross-functional coordination, and ownership of high-value deliverables. - Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment. - Strong written and verbal communication skills, including ability to synthesize complex information. - Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency. - Claims processing background. - Experience with Medicare, Medicaid, and/or Marketplace lines of business. - Payment integrity (PI) programs. Requirements - Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery. - Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives. - Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight. - Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies. - Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals. - Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries. - Analyzes data to identify and develop new recovery opportunities. - Conducts peer reviews of recovery concepts and offers recommendations for logical improvements. - Responsible for documenting policies and procedures related to concept approvals. - Conducts trainings and prepares training documentation for teams. Benefits - Molina Healthcare offers a competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.