1849 Patient Account Representative Medicare Medicaid Commercial Claims jobs near me

JOB DESCRIPTION Job Summary

Provides lead level engineering support for information technology (IT) big data architecture activities on Microsoft Azure cloud infrastructure. Representing as a Forward Deployed Engineer, responsible for leading the collection, storage, processing, and analysis of large health care payor datasets supporting Medicare/Medicaid operations. Designs enterprise-scale data solutions on Azure Databricks, Azure Data Factory, and Azure Synapse with emphasis on performance, scalability, and high-reliability. Champions AI-first practices, mentors team members, and drives adoption of machine learning and advanced analytics to improve member health outcomes. Partners strategically with business leaders to identify data-driven opportunities and delivers end-to-end solutions.

Essential Job Duties

• Operates as a lead Forward Deployed Engineer, driving end-to-end ownership culture and mentoring team members on business problem-solving.
• Provides subject matter expertise in Azure data platform architecture (Azure Databricks, Azure Synapse, Azure Data Factory, Azure Data Lake).
• Champions AI-first development practices, implementing GitHub Copilot workflows and Azure Machine Learning solutions for predictive health care analytics.
• Designs and implements business intelligence (BI) solutions using Power BI, Tableau integrated with Azure data platform.
• Analyzes current business practices and identifies opportunities for leveraging Azure data and AI PaaS services to improve Medicare/Medicaid operations.
• Builds reusable data quality frameworks and automated data validation using Azure DevOps and quality assurance automation tools.
• Leads integration initiatives connecting Azure data platform with low-code platforms (Pega, Salesforce, Sitecore).
• Converts business requirements into technical architecture, design and implementation for health care analytics use cases.
• Designs analytical data models supporting self-service BI for clinical, financial, and operational stakeholders.
• Implements batch and real-time data pipelines for claims processing, quality metrics, and population health analytics.
• Partners with business leaders across the organization to identify high-value data opportunities and prioritize initiatives.
• Leads technical issue resolution and collaborates with Azure support, infrastructure, and vendor teams.
• Supports project planning, scheduling and execution using Agile methodologies.
• Ensures HIPAA compliance and health care data governance standards are maintained.
• Provides training, mentoring and support to new and existing big data team members on Azure data technologies and Forward Deployed Engineer principles.

Required Qualifications

• At least 6 years of data management experience on cloud data platforms, or equivalent combination of relevant education and experience.
• Bachelor's degree in IT, computer science, statistics, business, health care, engineering, etc.
• Experience with Microsoft Azure data services (Azure Databricks, Azure Data Factory, Azure Synapse, Azure Data Lake Storage, Azure Machine Learning).
• Proven experience implementing AI-assisted development and machine learning solutions.
• Proficiency in Python, PySpark, Scala, and SQL with quality assurance automation experience.
• Experience with real-time streaming architectures (Kafka, Azure Event Hubs, Spark Streaming).
• Experience integrating data platforms with low-code systems (Pega, Salesforce).
• Health care payor industry experience with Medicare/Medicaid claims, quality metrics (HEDIS, Stars), and regulatory reporting.
• Understanding of HIPAA requirements and health care data governance frameworks.
• Ability to mentor and develop team members with Forward Deployed Engineer mindset.
• Experience with Azure DevOps CI/CD pipelines and Infrastructure as Code (Terraform, ARM templates).
• Critical-thinking and problem-solving skills with business outcome orientation.
• Ability to collaborate cross-functionally in a highly matrixed health care organization.
• Effective verbal and written communication skills, including ability to partner with executive stakeholders and translate business needs.
• Experience with Microsoft O365, Power BI, and Azure DevOps.

Preferred Qualifications

• Experience in the health care industry.
• Health care payor data experience including claims, eligibility, quality metrics, and regulatory reporting.
• Azure Data Engineer certification.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V