Role Description Performs research and analysis of complex healthcare claims data, pharmacy data, and contract data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and operations reports and makes recommendations based on relevant findings. This position is responsible for proactively identifying claim issues, resolving disputes, and coordinating solutions while overseeing and managing the activities of assigned providers from initiation to completion of the program. This role contributes to the strategic direction and organization of health plan initiatives, facilitating the successful implementation of provider engagement programs. - Analyze claims from compliance against contracts, billing, and processing guidelines - Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. - Responsible for timely completion of projects, including timeline development and maintenance, and coordination of activities and data collection with requesting internal departments or external requestors. - Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan - Collaborates with internal departments to determine root cause and analytical approach to payment discrepancies. - Apply investigative skills and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc. - Interact with various departments including; IT, Contracting, Corporate Services, Claims, Utilization Management, Configuration and Payment Integrity to understand claim-related policies and payment processes, member benefits, contracts and State requirements - Responsible for documenting job aids, billing guidelines, policies and procedures related to operations - Responsible for the submission, research, and resolution of provider inquiries and/or escalations - Participate in and support the development of strategies to meet business needs - Clarifies and supports organization policies and procedures - Communicate contract terms, payment structures, and reimbursement rates to physicians, hospitals and ancillary providers. - Implement and use software and systems to support the department’s goals. - Other duties as assigned Qualifications - Strong knowledge of provider data/processes/requirements related to provider contracting, credentialing, claims processing and state/federal regulations - Ability to interpret, communicate, and suggest revisions to core claims operation and data configuration SOP’s, BRDs, and/or guidelines as needed - Identify and implement continuous improvement opportunities as needed - Ability to manage various sources of information and large data sets including pharmacy, claims and encounter data - Proficiency in compiling data, creating reports and presenting information, including knowledge of Power BI Reports (or similar reporting tool), SQL query, MS Access and MS Excel - Ability to combine clinical and financial data - Demonstrated ability to meet established deadlines - Ability to function independently and manage multiple projects - Ability to develop scenario analysis using different approaches - Ability to present ideas and information concisely to varied audiences - Proficiency with PC-based systems, and the ability to learn other systems through knowledge of MS Excel and Access - Excellent verbal and written communication skills - Ability to quickly assimilate knowledge of processes and systems to develop and deliver necessary training to departmental staff and internal customers - Ability to work in a deadline driven department Requirements - Bachelor’s degree in finance, Economics, Computer Science; or combination of relevant education and experience - 4-6 years’ experience in a Managed Care Environment - 5-7 years of increasingly complex database and data management responsibilities - Claims processing background - Basic knowledge of SQL Preferred Experience - Multiple data systems and models - Complex database and data management responsibilities - Claims processing background - Configuration background Preferred Education - Bachelor’s Degree in Math or Business Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description The Cybersecurity Assurance Analyst (Audit) is an experienced member of the Information Security Compliance and Audit team with responsibilities for coordinating and executing a variety of compliance audit controls to ensure compliance with Information Security Policy, industry standards, and various compliance standards. - Monitor, test, and coordinate audit and compliance activities related to one or more specific compliance programs/standards. - Coordinate external audit activities on a periodic basis. - Support multiple compliance programs. - Facilitate working with internal customers of a wide variety of audiences. - Ensure that the necessary documentation is retained for review by other organizations as appropriate. Qualifications - Bachelor's degree with 6+ years of experience or Master's degree with 4+ years of experience. - 2-3 years practical experience with controls validation and compliance testing of CMMC audits, SSAE 16, AT-101 (SOC 1 / SOC 2), PCI, ISO, HIPAA, Privacy, NACHA, or SOX IT General Computer Controls auditing or similar audit experience. - Professional/technical certifications such as CISA, CISSP, GSEC, or CISM or willingness to pursue. Requirements - Work independently and as an experienced member of a team to manage the execution of multiple security controls validations simultaneously with specific deadlines. - Manage the assigned compliance program to successful completion each year. - Manage scope and project timelines and assist in managing the project budget. - Manage day-to-day vendor relationships and assist with vendor evaluations (or Requests for Proposals) as needed. - Suggest improvements to the compliance and audit control processes. - Document execution of information security controls and any findings identified during the control validation cycle. - Consult with control owners such as system administrators, database administrators, application owners and others on developing complete and repeatable control processes including control documentation such as procedures, control evidence, narratives, control matrices, metrics reports, etc. - Develop an understanding of each compliance standard and the validation requirements to satisfy the standards, including any policies, rules and regulations or laws governing the area reviewed. - Consult with internal clients on information security topics, providing guidance on compliance with corporate policy, standards, procedures, and industry best practices. - Communicate potential control gaps to management along with suggested remediation. - Educate and train process owners on compliance obligations. - Monitor and respond to customer and sales requests for information on various compliance initiatives. - Identify control deficiencies and/or process inefficiencies and develop process improvements. - Maintain and monitor progress of remediation steps on identified control deficiencies. Benefits - Comprehensive package featuring a broad range of Health, Life, Voluntary Lifestyle benefits and other perks that enhance your physical, mental, emotional and financial wellbeing. - Bonus structure (short-term incentives, long-term incentives and/or sales compensation).

• Develop an expert level understanding of Signify’s core product offerings and analytics technology • Write complex SQL queries to extract data from large databases for analysis and predictive modeling • Provide clinical insights through analyzing data including HCCs, Claims (ICD10, CPT, POS, etc), and HEDIS measures • Define, track, report out, and explain metrics representing the value of the product • Develop ad hoc analysis, dashboards, and visualizations to help non-technical consumers easily understand data correlations • Ensuring data accuracy, integrity, and compliance with regulations like HIPAA • Deliver defined HCS Clinical Analytics work on time and with high quality • Communicate and Coordinate regularly with stakeholders to execute strategic priorities • Other responsibilities as required to ensure company success.

• Analysing Distribution, Placement and Pricing data of the Category to deliver insights and recommendations for Sales to ensure Purina portfolio competitiveness across the channels and customers. • Supporting Key Account Managers with data, analysing, insights, and recommendations in preparation for Category assortment reviews. • Evaluating the effectiveness of trade activities through pre and post-evaluations, overviewing insights and making recommendations. • Preparing merchandising guidelines. • Participating in preparation and implementation of Category development projects with Key customers. • Participating in Customer meetings with Sales to present Category insights and development activities. • Collaborate closely with local cross functional team (Sales, Category Management, Marketing, Business Controlling, Demand Planning etc.).