California Claims Suspense Team Lead

Job Summary

Supporting California's Medi-Cal program, the remote California Claims Suspense Team Lead will manage the review, research, pricing, and resolution of suspended claims while providing guidance and training to Claims Examiners in a fast-paced, metrics-driven environment.

Key responsibilities

• Monitor and prioritize suspended claims inventories to meet turnaround times and service level requirements
• Support the processing and resolution of suspended claims in accordance with Medi-Cal guidelines and established procedures
• Provide day-to-day guidance and operational support to Claims Examiners, assisting with complex claims and inquiries

Required qualifications

• Three or more years of experience in healthcare claims processing, adjudication, or examination
• Experience in researching and resolving suspended or denied healthcare claims
• Previous experience in a team lead or senior claims role is preferred
• Knowledge of healthcare claims processing and reimbursement guidelines
• Strong analytical skills with a commitment to quality and accuracy