California Claims Adjustment Specialist

Job Summary

Working remotely, the full-time California Claims Adjustment Specialist will research, resolve, and complete disputes and adjustment requests while ensuring compliance with established guidelines and payment practices.

Key responsibilities

• Review and resolve submitted provider disputes, applying payments or requesting refunds as necessary
• Identify and document claims error patterns and trends, escalating issues as required
• Reprocess assigned claims and adjustment requests for accuracy and compliance

Required qualifications

• High school diploma or equivalent, with at least one year of experience at an analyst I level or equivalent
• Basic knowledge of Medi-Cal regulations and claims processing
• In-depth understanding of medical policy benefits and industry standard payment practices
• Familiarity with QNEX systems as they relate to claims processing
• Ability to handle confidential information with discretion