California Licensed Claims Specialist

Job Summary

To support a short-term assignment, the California Licensed Claims Specialist will manage technical support for appeals and call center tasks, handle escalated claim-related inquiries, and assist with complex claim adjustments while working remotely.

Key responsibilities

• Fulfill technical support needs for appeals and support staff, ensuring consistent and accurate task execution
• Perform root cause analysis for claim issues and collaborate with other business units to implement preventive solutions
• Assist in cross-training and identify training needs and Lean improvements for unit workflows

Required qualifications

• Four years of experience in a managed care environment focusing on claims processing, appeals, and customer service
• Thorough understanding of medical claim processing, including Medi-Cal/Medicare experience
• High school diploma or GED required
• Proficiency in Microsoft Office, particularly Advanced Microsoft Excel
• Ability to type a minimum of 45 wpm and demonstrate strong organizational skills