California Licensed Claims Analyst

Job Summary

Responsible for auditing claims data and adjustments for accuracy, the remote California Licensed Claims Analyst will manage claims processing and collaborate with internal and external customers while ensuring compliance with Medi-Cal regulations.

Key responsibilities:

• Review claims, appeals, and related documents to identify errors and facilitate corrections
• Document findings and compile reports to provide feedback on claims processing
• Monitor potential large loss claims and request reimbursements as necessary

Required qualifications:

• High school diploma or equivalent required; Associate's degree or higher in a 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, control, and monitoring processes preferred