Senior Claims Examiner

The Senior Claims Examiner is responsible for the accurate processing, adjustment, and adjudication of complex hospital, ancillary, and professional claims, with a primary focus on Medi-Cal managed care. This role requires extensive knowledge of California Medi-Cal regulations, delegated risk arrangements, and provider disputes, while also supporting Medicare and Commercial lines of business. The ideal candidate will serve as a subject matter expert, identifying processing issues, ensuring regulatory compliance, and maintaining high production and quality standards.