California Licensed Claims Analyst

Job Summary

Auditing claims data for accuracy, the remote California Licensed Claims Analyst will manage the processing of assigned claims, review documentation, identify errors, and collaborate with stakeholders to ensure compliance with regulations.

Key responsibilities

• Review claims, appeals, refunds, and related documents for accuracy and compliance
• Identify errors, analyze causes, and document findings for correction and adjudication
• Monitor potential large loss claims and collaborate with internal and external customers for information and feedback

Required qualifications

• High school diploma or equivalent; Associate's degree or higher in healthcare administration or related field preferred
• Minimum of three years of experience in medical claims processing, adjustments, and quality assurance
• In-depth knowledge of Medi-Cal regulations and medical terminology
• Experience with claims or medical billing/coding in the healthcare field
• Basic knowledge of audit and monitoring processes preferred