California Claims Adjustment Specialist

Working remotely, the full-time California Claims Adjustment Specialist will research, resolve, and complete disputes and adjustment requests while ensuring compliance with established guidelines and payment practices. Key responsibilities Review and resolve submitted provider disputes, applying payments or requesting refunds as necessary Identify and document claims error patterns and trends, escalating issues as required Reprocess assigned claims and adjustment requests for accuracy and compliance Required qualifications High school diploma or equivalent, with at least one year of experience at an analyst I level or equivalent Basic knowledge of Medi-Cal regulations and claims processing In-depth understanding of medical policy benefits and industry standard payment practices Familiarity with QNEX systems as they relate to claims processing Ability to handle confidential information with discretion