Jobs at Molina Healthcare Inc.

Leads complex insider threat investigations by analyzing technical and behavioral indicators across security, HR, and enterprise data sources. Conducts threat hunting, develops risk assessments, gathers evidence, and presents findings to executives. Enhances detection use cases, investigative procedures, dashboards, reporting, and monitoring capabilities. Partners with HR, Legal, Privacy, Compliance, Information Security, and business leaders to mitigate risks while ensuring investigations comply with privacy, legal, ethical, and organizational requirements.

Leads data intelligence for Medicaid, DSNP, and Marketplace procurement efforts. Analyzes claims, clinical, quality, network, operational, and competitive data; governs centralized repositories; develops proof points for RFPs; and provides strategic recommendations to proposal writers and growth leaders. Manages concurrent procurements, stakeholder relationships, reporting, continuous improvement, and staff development while supporting regulatory and competitive monitoring. Requires up to 40% business travel.

Analyzes healthcare claims, provider reimbursement, QPA, and dispute data to support No Surprises Act negotiations, arbitration, and OON liability management. Builds SQL-based reports, dashboards, data processes, and financial views; validates data quality; tracks dispute KPIs; integrates internal and external sources; and presents actionable recommendations to leadership and cross-functional stakeholders.

Supports enterprise-wide employee training by administering the LMS, coordinating programs, managing enrollments and logistics, facilitating virtual sessions, troubleshooting training-system issues, maintaining training resources, and preparing reports and metrics. Partners with business leaders to improve training effectiveness, processes, and learner support. Provides customer service to employees and leaders regarding LMS and training-related questions.

Leads enterprise IT infrastructure and service operations, overseeing service-level performance, ITSM processes, project intake, business requirements, reporting, budgets, process improvement, escalations, and stakeholder relationships. Develops service delivery plans, manages providers and SLAs, supports healthcare and Medicaid contract compliance, and guides cross-functional initiatives. Hires, mentors, and develops a high-performing IT team while ensuring reliable services, operational efficiency, and alignment with organizational goals.

Leads end-to-end program management across Provider Network functions, including governance, implementation, process improvement, change management, reporting, documentation, stakeholder engagement, vendor coordination, and resource planning. Develops requirements, test plans, playbooks, training materials, and performance dashboards while ensuring compliance and value realization across cross-functional initiatives.

Leads application engineering teams delivering cloud-native, AI-enabled solutions on Microsoft Azure for Medicare and Medicaid claims-processing operations. Oversees architecture, software development, quality automation, integrations, support, governance, security, vendor relationships, and large-scale implementations. Develops Azure applications as needed, mentors staff, manages cross-functional initiatives, ensures HIPAA compliance, and partners with business and executive stakeholders to improve healthcare payer outcomes.

Leads healthcare program and project delivery across multiple workstreams, managing scope, timelines, stakeholders, budgets, governance, risks, and dependencies. Analyzes dashboards, reports, operational metrics, and large datasets to identify performance gaps and recommend improvements. Develops policies, workflows, playbooks, business requirements, test plans, and training materials. Drives change management, provider engagement, quality improvement, compliance, reporting, and issue resolution across cross-functional teams.

Manages multiple Appeals and Grievances projects from inception through delivery, overseeing scope, schedules, resources, budgets, quality, stakeholders, and change management. Develops project plans, status reports, process documentation, SOPs, workflows, and PEGA job aids. Coordinates process improvements, governance changes, vendors, training, and cross-functional collaboration with executive, operational, and PEGA teams across multiple regions.

Provides senior engineering support for enterprise infrastructure and ServiceNow-enabled platforms across hybrid cloud, compute, storage, networking, databases, and automation. Leads complex deployments, configuration, monitoring, troubleshooting, security remediation, architecture reviews, and technical workstreams. Uses Azure, PowerShell, Python, Terraform, SQL, and observability tools to improve reliability and scalability. Collaborates with cross-functional teams, supports compliance and change management, mentors engineers, contributes to strategic roadmaps, and participates in on-call support.

Manages actuarial staff and oversees actuarial reporting, opinions, medical cost studies, pricing, liability estimates, financial projections, and rate filings. Reviews methodologies, interprets actuarial results, recommends solutions, and provides leadership insights. The role also includes hiring, mentoring, technical guidance, regulatory communications, and support for budgeting, acquisitions, and new business initiatives.

Leads competitive intelligence and market analysis for Medicaid, DSNP, and Marketplace RFPs. Reviews competitor responses, identifies gaps and differentiators, develops recommendations, maintains intelligence databases, supports capture strategy and oral presentations, and advises business development, product, legal, and executive stakeholders. Provides benchmarking, proposal analytics, training, and protest support while refining RFP methodologies. Requires 50% or more travel.

Leads enterprise data, analytics, business intelligence, and AI strategy across healthcare payer functions. Partners with executives to prioritize analytics initiatives, build reporting and predictive insight capabilities, establish data governance and accountability, and drive measurable business outcomes. Oversees cross-functional teams, enterprise application development, Azure architecture, quality automation, DevOps, and intelligent automation while engaging C-suite and board stakeholders.

Supports Molina Healthcare’s corporate development and M&A strategy by sourcing and evaluating opportunities, building financial and valuation models, coordinating due diligence and transaction activities, supporting agreement negotiations, preparing leadership presentations, and assisting with post-acquisition integration. The role requires cross-functional collaboration, strong financial analysis, project management, negotiation, communication, and organizational skills.

Leads complex business and technology programs across the full lifecycle, coordinating multiple project teams and stakeholders. Develops integrated plans, manages dependencies, risks, scope, timelines, resources, and budgets, and tracks program KPIs. Facilitates governance meetings, communicates status and outcomes to leadership, maintains documentation, supports decision-making, and drives alignment with business priorities. May mentor team members and coordinate continuous improvement activities.

Owns the vision, backlog, prioritization, delivery, and lifecycle of EDI solutions and technical products. Translates stakeholder and regulatory needs into requirements, epics, features, and user stories; leads Agile ceremonies; accepts delivered work; and partners with engineering, QA, data, architecture, operations, health plans, compliance, legal, and audit teams. Monitors product outcomes, mitigates risks, supports modernization, and ensures documentation, controls, security, and regulatory requirements remain audit-ready.

Supports health plan finance through monthly close, budgeting, forecasting, regulatory reporting, financial modeling, variance analysis, and ad hoc leadership reporting. Evaluates financial information, investigates discrepancies, develops finance policies and procedures, and recommends actions related to investments, operations, product development, and regulatory initiatives. Collaborates with technical and non-technical stakeholders and manages multiple deadlines.

Manage MMISR program activities including configuration, testing, workflows, governance, vendor practices, budgets, performance tracking, and stakeholder coordination. Produce requirements, test plans, training materials, and recurring reports while driving process improvements and adoption of program guardrails.

Lead a configuration/product team delivering and maintaining enterprise configuration and claims solutions. Own product vision, backlog, and delivery; partner with stakeholders, engineering, QA, compliance, and health plans to ensure scalable, compliant solutions and operational efficiency.

Lead enterprise data architecture and platform engineering efforts using Databricks Lakehouse. Design scalable cloud-native data platforms, implement medallion architectures, enable data governance and AI/ML workloads, build automation and CI/CD for Databricks, and mentor teams while collaborating with stakeholders on strategy and delivery.