REMOTE Claims Examiner

Professional Summary

Detail-oriented and highly organized claims specialist with expertise in D‑SNP (Dual Eligible Special Needs Plan) claims processing. Skilled in researching, correcting, and resolving pended claims, ensuring compliance with regulatory guidelines, and maintaining accurate documentation. Adept at working in high‑volume environments with strong attention to detail and excellent communication skills.

• Research, correct, and respond to all D‑SNP pended claims in a timely manner.
• Review audit reports and determine claim payment eligibility in accordance with policies and procedures.
• Maintain accurate correspondence and documentation for medical procedures, CPT, and HCFA codes.
• Review, price, and release claims for assigned claim types (paper and electronic).
• Analyze Manual Review reports for suspended D‑SNP claims.
• Stay current on all D‑SNP policies and contribute to departmental improvement projects.
• Ensure compliance with all regulatory guidelines and monitor adherence.
• Maintain daily activity logs and assist with claims processing.
• Perform additional duties and special projects as assigned.

• Claims Processing
• Project Management
• Healthcare Operations
• Workflow Optimization
• Medical Terminology & Coding

• QNXT platform proficiency
• Strong knowledge of D‑SNP program
• Expertise in dual eligible claims processing (Medi‑Cal and Medicare D‑SNP)

• Prior experience in high‑volume production environments
• Excellent oral and written communication skills
• Strong attention to detail
• Medical terminology and/or coding experience highly desirable

Entry Level

This is a Contract position based out of Santa Barbara, CA.

The pay range for this position is $24.00 - $27.00/hr eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre‑tax and Roth post‑tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long‑term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Jan 21, 2026.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.