Cencal Health
Job Details
Job Location Main Office - Santa Barbara, CA
Remote Type Fully Remote
Position Type Full Time
Salary Range $23.30 - $32.62 Hourly
Job Category Claims
Job Posting Date(s)
Start Date 09/08/2025
Description
Central Coast Salary Range
- $23.30/hour - $32.62/hour
While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.
Job Summary
This position is responsible for: researching, correcting and responding to all D-SNP pended claims as well the review of Audit reports in a timely manner; determining whether a claim should be paid (in accordance with the policies and procedures) and maintaining correspondence for document procedure /medical/CPT/ HCFA codes; assuring all regulatory guidelines are being followed.
Duties and Responsibilities
Review, price and release claims associated with the assigned claim types (paper and electronic) Review Manual Review reports that suspend for review for D-SNP claims Keep up to date on all D-SNP policies and provide materials for improvement projects within Department Assure all regulatory guidelines are being followed and monitored Maintain daily activity log Assist with the processing of claims Other duties and projects assigned Qualifications
Knowledge/Skills/Abilities
QNXT experience Strong knowledge of the D-SNP program Strong knowledge in dual eligible claims processing (Medi-Cal and Medicare D-SNP ) Prior experience in high volume production environment Good oral and written communication skills Attention to detail Medical terminology and/or coding experience is highly desirable Education and Experience
Required:
High school diploma or equivalent Three (3) years' experience as a Claims Examiner
Job Location Main Office - Santa Barbara, CA
Remote Type Fully Remote
Position Type Full Time
Salary Range $23.30 - $32.62 Hourly
Job Category Claims
Job Posting Date(s)
Start Date 09/08/2025
Description
Central Coast Salary Range
- $23.30/hour - $32.62/hour
While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.
Job Summary
This position is responsible for: researching, correcting and responding to all D-SNP pended claims as well the review of Audit reports in a timely manner; determining whether a claim should be paid (in accordance with the policies and procedures) and maintaining correspondence for document procedure /medical/CPT/ HCFA codes; assuring all regulatory guidelines are being followed.
Duties and Responsibilities
Review, price and release claims associated with the assigned claim types (paper and electronic) Review Manual Review reports that suspend for review for D-SNP claims Keep up to date on all D-SNP policies and provide materials for improvement projects within Department Assure all regulatory guidelines are being followed and monitored Maintain daily activity log Assist with the processing of claims Other duties and projects assigned Qualifications
Knowledge/Skills/Abilities
QNXT experience Strong knowledge of the D-SNP program Strong knowledge in dual eligible claims processing (Medi-Cal and Medicare D-SNP ) Prior experience in high volume production environment Good oral and written communication skills Attention to detail Medical terminology and/or coding experience is highly desirable Education and Experience
Required:
High school diploma or equivalent Three (3) years' experience as a Claims Examiner