Job Description

Are you an experienced healthcare claims professional looking for a **remote position** with a company that values your skills and offers long-term growth potential? Our client, a leading healthcare organization, is seeking a **Claims Processor** with **strong experience in Medi-Cal and Medicare claims**—especially for **professional claims** submitted by specialists such as Cardiologists, Surgeons, and OB-GYNs.

🧩 What You’ll Do:

* Review and process **non-delegated provider claims** (professional and outpatient)

* Ensure claim accuracy and verify services against **Medicare/Medi-Cal fee schedules**

* Determine eligibility for payment or denial

* Handle **coordination of benefits (COB)**, denials, and service reductions

* Collaborate with internal teams to resolve claim issues and ensure timely processing

✅ What We’re Looking For:

** Must live in Southern California***

* **2+ years** of hands-on experience in **professional or institutional claims processing**

* Proven knowledge of **Medicare and Medi-Cal** guidelines, policies, and fee schedules

* Strong understanding of **CPT**, **ICD-9**, and **ICD-10** coding

* Familiarity with **capitated managed care** (a plus!)

* Proficiency in **Windows-based applications** and solid **data entry** skills

* Highly organized, detail-oriented, and able to thrive in a remote setting

💻 Why You’ll Love This Role:

* 100% **remote work** – enjoy work-life balance from anywhere in the U.S.

* Join a **mission-driven team** making a real impact in healthcare

* Competitive pay and potential for **long-term placement**

* Work independently while still being part of a **collaborative team environment**

Job Tags

Similar Jobs