Medical Claims Research Analyst Lead - Remote California

Summary

The Medical Claims Research Analyst Lead serves as a functional lead for the Research Analyst team, providing guidance, support, and expertise in the resolution of complex claims research, provider inquiries, correspondence, and operational issues.

This role collaborates with internal departments, leadership, providers, clients, and external stakeholders to ensure timely, accurate, and compliant research outcomes while promoting operational excellence and continuous process improvement. The ideal candidate demonstrates strong leadership, analytical, communication, and problem-solving skills and serves as a subject matter expert for complex inquiries and escalations.

Your role in our mission

• Provide functional leadership and day-to-day guidance to the Research Analyst team, supporting complex inquiries, escalations, claims research, and correspondence while promoting consistency, quality, and timely resolution.
• Support the investigation and resolution of routine to highly complex medical claims, provider, client, and operational inquiries using subject matter expertise, independent judgment, and established policies and procedures.
• Collaborate with providers, clients, leadership, and cross-functional business partners to resolve escalated issues, support program initiatives, and ensure compliance with applicable requirements.
• Contribute to knowledge management resources, develop best practices, and support staff training and mentoring while documenting complex issue resolution and operational guidance.
• Identify process improvement opportunities, analyze operational trends, and recommend solutions that improve efficiency, service delivery, customer satisfaction, and business outcomes.

What we're looking for

• Three or more years of experience in healthcare operations, medical claims processing, provider support, customer service, business process outsourcing, research, or a related field; Medi-Cal or Medicaid experience preferred.
• Demonstrated functional lead experience with the ability to provide direction, coaching, mentoring, and support within a team environment.
• Strong analytical, research, problem-solving, organizational, and decision-making skills.
• Excellent written, verbal, interpersonal, presentation, and facilitation skills with the ability to collaborate effectively with providers, clients, leadership, and cross-functional teams.
• Experience assessing business processes, identifying improvement opportunities, and developing practical solutions that improve operational effectiveness and service quality.
• Working knowledge of healthcare regulations, provider operations, medical claims processing, customer support practices, and business systems used to research, track, and resolve inquiries.

What you should expect in this role

• Remote position; must reside in California.
• Occasional onsite attendance may be required for meetings, training, operational initiatives, or other business needs.
• Reliable high-speed internet connectivity is required.
• Opportunity to provide leadership, subject matter expertise, and operational support for critical provider and client-focused programs.

This is a pipeline requisition designed to build a pool of qualified candidates for current and future opportunities as positions become available.

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