Claims Analyst

Company Overview

Full Circle Health Network is an integrated network of nonprofit, nationally accredited providers delivering coordinated, community-based services to vulnerable children, individuals and families across California.

Full Circle exists to ensure more Californians can access culturally congruent and trauma-informed care from a high-quality network of community-based organizations that address their whole-person and whole-family needs.

We accomplish this primarily through the following core activities:

• Serve as a single contracting vehicle for community-based providers to enroll in Medi-Cal managed care plan networks.
• Reduce administrative burden for providers so they can focus on serving clients.
• Drive improved coordination between providers across multiple systems through technology infrastructure, training, and administrative practice support.

The Full Circle Health Network embraces the population health vision of CalAIM. Healing trauma, stabilizing home environments, and reuniting families promotes wellness throughout a child’s lifetime reaping innumerable future individual and societal benefits.

Full Circle Health Network is closely affiliated with the CA Alliance of Child and Family Services, under the governance of the California Alliance Board of Directors. The Network has an advisory board made up of subject matter experts and participants of the network.

Position Overview

The Claims Analyst supports Full Circle Health Network’s mission by ensuring accurate, timely, and compliant claims and encounter management for network providers. This role is responsible for claims intake and review, issue resolution, data validation, reporting support, and coordination with internal teams, providers, and payer partners to reduce denials, improve first-pass resolution, and strengthen operational performance.

Reporting to the Manager, Claims Oversight, the Claims Analyst will monitor claims workflows, identify trends and errors, support provider education and technical assistance, and ensure documentation is complete and aligned with contractual requirements, payer policies, and regulatory standards.

This role requires strong attention to detail, consistent follow-through, and the ability to communicate effectively across teams while supporting a high-volume environment.

The role may require occasional travel for in-person meetings, provider support, and statewide engagements.

Location: California (Remote/Hybrid)

Work Location Requirement: Candidate must reside in California.

Key Responsibilities

Claims & Encounter Oversight

• Review incoming claims/encounter submissions for completeness, accuracy, and compliance with payer requirements (e.g., Medi-Cal managed care, delegated arrangements, and contractual terms).
• Identify and correct errors related to eligibility, authorization, coding, modifiers, provider information, and documentation requirements.
• Track claims status through lifecycle stages (submitted, accepted, denied, pended, paid) and coordinate follow-up actions.
• Support reconciliation of remittance advice, payment variance, and denial data as needed.

Denial Management & Resolution

• Analyze denials and payment issues, determine root cause, and recommend corrective actions.
• Coordinate with provider billing teams, internal operations, and payers to resolve claim issues within required timeframes.
• Maintain documentation of outreach, resolutions, and recurring issues; escalate complex issues appropriately.
• Support appeals and reconsiderations by gathering required documentation and ensuring submissions meet payer requirements.

Data Integrity, Reporting & Performance Improvement

• Monitor claims/encounter quality metrics (e.g., clean claim rate, denial rate, timeliness, resubmission volume).
• Generate and maintain tracking logs and dashboards (Excel/Sheets) to support operational oversight.
• Identify workflow gaps and recommend process improvements that reduce rework and prevent recurring denials.
• Support audits and reporting requests by providing accurate claim data and documentation.

Provider Support & Cross-Functional Collaboration

• Provide clear and timely communication to providers on claim issues, documentation gaps, and resolution steps.
• Partner with Network Operations, Finance, Compliance, and IT teams to improve systems alignment and workflow efficiency.
• Participate in payer/provider meetings as needed to resolve systemic issues and improve performance.
• Contribute to provider guidance materials and internal SOPs to support consistent submissions.

Compliance & Confidentiality

• Ensure all work complies with HIPAA and applicable state/federal privacy regulations.
• Follow organizational policies for data security and the handling of protected health information (PHI).
• Maintain accurate records and ensure reporting is complete and audit-ready.

Qualifications

Location: California (Remote/Hybrid)

Work Location Requirement: Candidate must reside in California.

Required

• 2 years of experience in claims processing, revenue cycle, billing, or claims/encounter analysis (healthcare, behavioral health, or managed care preferred).
• Strong working knowledge of claims workflows, denials, eligibility, authorizations, and documentation standards.
• Proficiency with Excel/Google Sheets (filters, pivot tables, lookups preferred).
• Ability to interpret payer policies and apply them to claims resolution and documentation requirements.
• Strong communication skills and ability to work collaboratively across teams.
• High attention to detail and ability to manage multiple priorities in a deadline-driven environment.

Preferred

• Experience working with Medi-Cal managed care plans and/or delegated provider networks.
• Knowledge of CPT/HCPCS, ICD-10, modifiers, and authorization workflows.
• Experience with EHR and/or claims submission platforms (clearinghouses, payer portals, etc.).
• Familiarity with CalAIM programs and community-based behavioral health services.
• Experience in nonprofit or community-based healthcare settings.

Compensation & Benefits

• Hourly pay: $36.06 – $40.87/hour, commensurate with experience (annualized equivalent: $75,000–$85,000)
• Comprehensive benefits package including health, dental, vision, and retirement contributions
• Flexible hybrid work model with statewide impact
• Opportunities for professional development and growth within a mission-driven organization

To Apply

Submit your resume and brief cover letter to HR@fullcirclehn.org. Candidate submissions will be evaluated in the order they are received. Hiring is ongoing until the position is filled.

Additional Employment Information:

Equal Employment Opportunity

Full Circle Health Network is an equal opportunity employer and is committed to building a diverse and inclusive workforce. We do not discriminate on the basis of race, color, religion, creed, sex, gender identity or expression, sexual orientation, national origin, ancestry, age, disability, medical condition, genetic information, marital status, veteran status, or any other status protected by applicable federal, state, or local law.

Reasonable Accommodation

Full Circle Health Network provides reasonable accommodations for qualified individuals with disabilities and for sincerely held religious beliefs, in accordance with applicable law. Applicants requiring accommodation during the application or interview process may contact the organization to request assistance.

At-Will Employment

Employment with Full Circle Health Network is at will. Nothing in this job posting or the application process creates an express or implied contract of employment for any specific duration.

Background and Reference Checks

Employment offers may be contingent upon the successful completion of reference checks and any background screening required by law or funding partners.