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Why this grade This listing scored 48/100, which is a D. It lost the most ground on pay transparency. See the breakdown
- Description depth 20 / 20 How much the posting actually says about the work, measured in characters of real text.
- Pay transparency 12 / 25 A published salary range, worth more than any other single factor because it is what a candidate cannot find out without applying.
- Freshness 8 / 15 How recently it was posted. Older postings are likelier to be filled or abandoned.
- Remote clarity 8 / 15 Whether "remote" means anywhere, or is quietly restricted to one country.
- Corroboration 5 / 10 Whether more than one source carries this listing.
- Role specificity 0 / 10 Whether the listing is tagged well enough to tell what the role actually is.
-5 Ghost-job penalty — Deducted for signals that this posting may not be a real, currently-open role — staleness, repeated relisting, or talent-pool language.
Every figure above is arithmetic over the posting itself — its salary field, its text, its age, its tags and how many sources carry it. How the grades work →
Overview
Who We Are: Qualfon is a global provider of omnichannel customer experience and business support solutions. From call center support to lead generation to ecommerce fulfillment, we support our clients and their customers throughout the customer journey. Our mission is to help as many people as possible pursue their total vocation - as individuals and as members of society by creating an ever-growing number of job opportunities as we strive to become the partner of choice for our clients. At Qualfon, you’ll find more than just a job, you’ll find a place to grow, develop your career, and be part of a supportive, purpose-driven team.Responsibilities
What You’ll Do:As a Medi-Cal Claims Examiner, you will be responsible for reviewing, processing, and adjudicating suspended healthcare claims to ensure accurate and timely payment. You will apply Medi-Cal policies, regulations, and reimbursement guidelines while evaluating member eligibility, provider information, authorizations, benefits, and supporting documentation. This role is ideal for a detail-oriented professional who enjoys analyzing claims, resolving issues, and working in a fast-paced healthcare environment while maintaining a high standard of accuracy and confidentiality.
- Review and adjudicate suspended claims to ensure accurate processing and payment in accordance with established guidelines.
- Confirm member eligibility, provider information, required authorizations, and covered benefits.
- Evaluate medical records, claim forms, billing details, and supporting documentation to determine appropriate claim outcomes.
- Identify discrepancies and resolve claim errors to ensure accurate adjudication.
- Investigate and resolve claims-related issues while meeting established quality, productivity, and turnaround-time standards.
- Apply Medi-Cal policies, regulations, reimbursement rules, and payment guidelines consistently and accurately.
- Analyze claim information and interpret applicable policies and procedures to determine the appropriate resolution.
- Safeguard protected health information and maintain compliance with HIPAA and organizational confidentiality requirements.
- Partner with internal teams to address complex claims issues and escalate matters requiring additional review or resolution.
- Accurately document claim reviews, actions taken, and final adjudication decisions in the appropriate systems
Qualifications
What You’ll Bring:
- At least two (2) years of experience in Medicaid/Medi-Cal claims processing and adjudication.
- Working knowledge of healthcare claims, medical terminology, and billing practices.
- Familiarity with CPT, HCPCS, and ICD-10 coding principles.
- Strong attention to detail and a commitment to maintaining accuracy while meeting productivity and turnaround-time expectations.
- Ability to understand, interpret, and apply policies, procedures, regulatory requirements, and payment guidelines.
- Strong analytical, organizational, and time-management skills with the ability to prioritize competing tasks.
- Ability to perform effectively in a high-volume, fast-paced production environment.
- Excellent verbal and written communication skills.
- Ability to independently research, analyze, and resolve claims issues using established guidelines and resources.
- Proficiency with claims processing systems, Microsoft Office, and other computer-based applications.
- Demonstrated ability to protect confidential information and appropriately handle sensitive member and provider data.
Pay Range
USD $24.00 - USD $24.00 /Hr.Originally posted on Himalayas
Apply for this role Opens himalayas.app — the link as listed; we have not yet verified it is the employer's own page
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Where this listing came from
- 07 Sep 2026 Himalayas first sighting
Seen on 1 board over 0 days.