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**
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