Hiring: Claims Examiner II Company: Partnership HealthPlan of California Location: Shasta County, CA Job Posted Time: 2026-09-03 07:38:56 About the job Experience: •Effective written and oral communication skills. Good organization skills. Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD-10 knowledge preferred. Required Skills: •Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report. •Routes claims to appropriate Partnership departments and internal staff for additional review. Follows up and completes claims once response to request has been received. •Follows established Partnership policies and procedures, Partnership Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims. •Generates claims correspondence as needed. •Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor. •Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame. •Supports Claims Department’s needs for resolving all pended claim types. •Participates in special projects and assignments as required. Qualifications: •High school diploma or equivalent; minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment. •Special Skills, Licenses and Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!