California Licensed Medical Claims Analyst

Job Summary

Supporting providers and clients, the remote California Licensed Medical Claims Analyst will conduct comprehensive medical claims research, resolve inquiries, and collaborate with cross-functional teams to enhance operational support.

Key responsibilities:

• Research, analyze, and resolve routine to complex medical claims and provider inquiries using established policies and procedures
• Manage claims research and correspondence by prioritizing assignments and ensuring timely resolution of issues
• Collaborate with providers, clients, and leadership to facilitate escalations and support program initiatives

Required qualifications:

• Three or more years of experience in healthcare operations, medical claims processing, or related fields; Medi-Cal or Medicaid experience preferred
• Experience in researching and resolving medical claims and provider inquiries
• Strong analytical and decision-making skills with the ability to manage multiple priorities
• Working knowledge of provider operations and medical claims processing
• Experience identifying process improvement opportunities and developing practical solutions