Molina Healthcare

Investigator, Special Investigative Unit Coding (Remote)

United States

Sponsorship not specifiedDetected 3 days ago

ExcelICD-10ResearchCommunicationProblem SolvingMicrosoft OfficeClaims Management

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odds of building a lasting career here

31Risky

Cap-exempt (no lottery)0

Sponsors this role58

Entry-level history0

PERM / green-card track0

Lottery odds40

Fits your clock70

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Employer immigration record

from this employer's Department of Labor filings

Green-card filing pattern in this occupation

Context, not a finding about this posting: of this employer's 7 green-card filings in this occupation, 100% were for a worker who already held the job.

Green-card follow-through: 40%

Of 5 labor certifications old enough to have been used, 3 expired without the employer filing the next step. Median time from filing to decision: 500 days.100% of their filings were for a worker who already held the job.Only certifications past the 180-day window are counted — recent ones cannot have expired yet.

Files H-1B transfers

2 transfer filings in the last year, covering 2 workers. Median labor-condition decision: 8 days. An employer that already files transfers is one that can take over an existing H-1B.

Sourced from Department of Labor LCA, PERM and prevailing-wage disclosure data. Employer matching is by name, so figures may be split across an employer's legal entities. Absence of a filing means none appears in our copy of the data, not that none exists.

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About the role

Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments.
Communicates and participates in meetings related to cases.
Completes medical review to facilitate referral to law enforcement or payment recovery.

Requirements

Supports investigation work as necessary and required by the regulatory agency.
Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations.
Knowledge of managed care and the Medicaid, Medicare, and Marketplace programs.
Ability to research and interpret regulatory requirements.
Ability to work in a team setting.
Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).

Nice to have

Experience with claims processing systems.
Ability to use Microsoft Excel platform and work with large quantities of data.
Ability to answer questions, identify trends and patterns, and present findings.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Skills

Critical-thinking, problem-solving and analytical skills.
Strong verbal/written communication skills, and presentation skills.

Compensation

Molina Healthcare offers a competitive benefits and compensation package.

Benefits

Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims.
Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
Provides support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA).

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This listing is sourced directly from Molina Healthcare's careers page and normalized into a canonical job model.