California Licensed Research Analyst

Job Summary

To support critical provider and client-focused programs, the full-time California Licensed Research Analyst will lead a team in investigating prepayment fraud, waste, and abuse, while working in a hybrid environment that combines remote and occasional in-office duties.

Key responsibilities

• Provide functional leadership and guidance to the research analyst team in resolving inquiries related to fraud, waste, and abuse
• Gather and document supporting evidence for medical consultant reviews, ensuring timely and accurate case documentation
• Collaborate with cross-functional teams to investigate leads and ensure compliance with organizational policies and regulatory requirements

Required qualifications

• Three or more years of experience in healthcare operations, claims processing, or a related field; Medi-Cal experience preferred
• Demonstrated experience in a functional lead role with strong analytical and decision-making skills
• Excellent written and verbal communication skills for effective collaboration with stakeholders
• Experience in assessing business processes and identifying opportunities for improvement
• Working knowledge of healthcare regulations and claims processing systems