California Licensed Claims Specialist
Job Summary
Ensuring the integrity of claims data, the full-time California Licensed Claims Specialist will utilize quality auditing tools and identify training needs while working remotely under the direction of the Claims Quality Assurance Manager and Supervisor.
Key responsibilities
- Conduct quality audits of claims data to ensure accuracy and compliance
- Identify training needs and develop effective methods for data entry and adjudication
- Support the implementation of quality program goals related to HEDIS, CAHPS, and NCQA Accreditation
Required qualifications
- Two years of experience in examining and processing institutional and professional claims
- High school diploma or GED required
- Medicare/Medi-Cal experience preferred
- Familiarity with ICD-9/ICD-10 and CPT coding
- Experience in a managed care environment is helpful
Complete Job Description
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