California Licensed Medical Claims Analyst Lead

Job Summary

Providing functional leadership and support, the full-time remote California Licensed Medical Claims Analyst Lead will guide the Research Analyst team in resolving complex claims inquiries, collaborating with various stakeholders to ensure operational excellence and compliance.

Key responsibilities

• Lead the Research Analyst team in addressing complex claims, inquiries, and correspondence while ensuring quality and timely resolutions
• Investigate and resolve routine to highly complex medical claims and operational inquiries using established policies and procedures
• Collaborate with providers, clients, and internal departments 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 mentor and support team members
• Strong analytical and problem-solving skills with a focus on operational effectiveness
• Working knowledge of healthcare regulations and medical claims processing
• Excellent interpersonal and communication skills for effective collaboration with various stakeholders