• Assess the quality of physician reports, ensuring they meet all client and jurisdictional standards specific to long-term disability claims • Verify that the claims support the physicians determinations in long-term disability claims • Read and apply policy guidelines and healthcare terminology, determining when criteria for long-term disability are met • Provide strong customer service by working closely with clients on a case-by-case basis to deliver complete, timely, and error-free quality assurance for long-term disability cases • Manage and provide oversight for complex long-term disability cases requiring additional review prior to returning to the client • Serve as an additional level of QA for cases with quality issues, utilizing clinical claims knowledge specific to long-term disability • Participate in other duties and special projects, as assigned, based on business needs

• Oversight of QA staff • Ensure appropriate QA staff are assigned to each file to designate file handling responsibilities amongst the team • Supervise the assigned staff and manage the File Review Board to ensure a timely and accurate process of each file • Provide details of board reviews to managers to ensure efficiency and productivity of staff • Assist in identifying & correcting staff performance including promotions, discipline, coaching and termination of staff • Assist in hiring qualified candidates for QA open positions • Ensure that all QA staff adhere to and meet their specific job duties • Following up with Physicians for outstanding reports • Reviewing received reports for accuracy • Delivering completed reports back to all applicable parties • Following all client-specific instructions • Actively participate in issue resolution by working with the required QA, physicians, account managers, and/or other related parties • Follow up with physicians with any additional questions or need for further clarification • Ensure referrals meet the client-directed Turn Around Time (TAT) • Ensure correct Doctor Payment amount and Client Invoice amount upon approval of referrals • Review reports accompanying medical records to ensure that the report is complete, that all questions posed have been addressed and that the report is free of errors • Assist management team with intake completion • Act as the liaison between the reviewer, team member and client regarding the process or status of the file • Assist in communications with the requester regarding questions and issues • Other duties & special projects, as assigned and based on business needs

Role Description Provides support for Molina enterprise quality improvement abstraction activities. Responsible for data collection and abstraction of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) and HEDIS-like initiatives and compliance, and supplemental data collection activities. Meets chart abstraction productivity standards and minimum overread standards. - Facilitates HEDIS medical record review, including ongoing review of records submitted by providers and the annual HEDIS medical record review process. - Participates in meetings with the national overread team, national quality training team, the regional HEDIS team, vendors and HEDIS auditors for quality/HEDIS review activities to coordinate medical records and quality-related initiatives. - Participates in meetings with vendors to enable the medical records collection process. - As needed, may collect medical records and reports from provider offices, load data into the HEDIS application, and compare documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed. Qualifications - At least 2 years of experience in the health care industry, preferably in a quality-related role, or equivalent combination of relevant education and experience. - Basic knowledge and understanding of HEDIS and NCQA. - Attention to detail and organizational skills. - Ability to work independently in a fast-paced, deadline-driven environment. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs. Preferred Qualifications - Medical record abstraction experience. - Experience with HEDIS audits (including but not limited to chart collection, project management, etc.). - Managed care experience. - Intermediate knowledge related to HEDIS and National Committee for Quality Assurance (NCQA). - Registered Nurse (RN). If licensed, licensed must be active and unrestricted in state of practice. Benefits - Molina Healthcare offers a competitive benefits and compensation package.

• Architect and break down ambiguous product problems into concrete, well-scoped test cases and test plans, owning work from design through production release. • Contribute to our AI-first engineering culture, share patterns, document what works, and help the team level up on how we build with AI. • Use AI tools fluently - Claude Code, Augment or equivalent, to compress implementation time, then critically review everything that comes out of them. • Collaborate closely with Product and Design to identify gaps in specs, surface edge cases early, and push back when something isn't ready to ship. • Set the quality bar: well-structured, maintainable code; conduct thorough code reviews; maintain adequate test coverage; and catch bugs AI introduced before they reach production.