This is a fully remote position, open to applicants in California.

📋 Description

• Oversee inventories of suspended claims and assist in prioritizing aging claims to fulfill turnaround times and service level standards.

• Evaluate, research, price, process, and resolve suspended claims in accordance with Medi-Cal guidelines, policies, and procedures.

• Provide daily guidance, training, and operational support to Claims Examiners.

• Aid in handling complex claims and addressing inquiries.

• Monitor team productivity, quality, claims inventory, and other key operational metrics.

• Alert the Claims Suspense Supervisor to potential issues or trends.

• Identify concerns related to workflow, quality, and processing.

• Contribute to enhancements in claims accuracy, productivity, and overall operational performance.

• Act as backup for the Claims Suspense Supervisor.

• Assist in coordinating daily team activities and setting priorities.

⛳️ Requirements

• A minimum of three years of experience in healthcare claims processing, claims adjudication, claims examination, claims suspense, Medicaid/Medi-Cal, or a similar healthcare claims function.

• Proficient in researching and resolving suspended, pended, denied, or exceptional healthcare claims.

• Preferred experience in a team lead role, senior claims examiner, senior claims processor, or similar position providing daily guidance and support to team members.

• Familiarity with healthcare claims processing, claims policies and procedures, reimbursement or pricing guidelines, and healthcare or insurance terminology.

• Strong analytical and problem-solving abilities.

• Exceptional attention to detail and dedication to quality and accuracy.

• Excellent communication and organizational skills.

• Capability to prioritize tasks and support a team in a fast-paced, metrics-focused claims environment.

• Broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload.