California Licensed Claim Examiner
A company is looking for a Business Analyst specializing in claims examination. Key Responsibilities Review, process, and adjudicate high-complexity healthcare claims in compliance with policies and regulations Ensure accurate application of relevant medical codes including CPT, ICD-10, and HCPCS Investigate and resolve complex claim discrepancies and issues Required Qualifications 5-6 years of experience with EZ-CAP Experience with Medi-Cal (California Medicaid) Knowledge of healthcare claims processing and adjudication Familiarity with medical coding standards Ability to assess medical necessity and coverage eligibility
A company is looking for a Business Analyst specializing in claims examination.
Key Responsibilities
Review, process, and adjudicate high-complexity healthcare claims in compliance with policies and regulations
Ensure accurate application of relevant medical codes including CPT, ICD-10, and HCPCS
Investigate and resolve complex claim discrepancies and issues
Required Qualifications
5-6 years of experience with EZ-CAP
Experience with Medi-Cal (California Medicaid)
Knowledge of healthcare claims processing and adjudication
Familiarity with medical coding standards
Ability to assess medical necessity and coverage eligibility
