California Licensed Medical Claims Analyst

Job Summary

Providing functional leadership for the Research Analyst team, the full-time California Licensed Medical Claims Analyst will support complex claims research, provider inquiries, and operational issues in a remote work environment.

Key responsibilities

• Lead and guide the Research Analyst team in resolving complex inquiries and ensuring timely, accurate outcomes
• Investigate and resolve routine to highly complex medical claims and operational inquiries using subject matter expertise
• Collaborate with internal and external stakeholders to address escalated issues and support program initiatives

Required qualifications

• Three or more years of experience in healthcare operations, medical claims processing, or a related field; Medi-Cal or Medicaid experience preferred
• Demonstrated experience in a functional lead role with the ability to coach and mentor team members
• Strong analytical and decision-making skills with a focus on operational effectiveness
• Working knowledge of healthcare regulations and medical claims processing
• Excellent interpersonal and communication skills for effective collaboration