California Licensed Claim Examiner

Job Summary

A company is looking for a Business Analyst specializing in claims examination.

Key Responsibilities

• Review, process, and adjudicate high-complexity healthcare claims in compliance with policies and regulations
• Ensure accurate application of relevant medical codes including CPT, ICD-10, and HCPCS
• Investigate and resolve complex claim discrepancies and issues

Required Qualifications

• 5-6 years of experience with EZ-CAP
• Experience with Medi-Cal (California Medicaid)
• Knowledge of healthcare claims processing and adjudication
• Familiarity with medical coding standards
• Ability to assess medical necessity and coverage eligibility