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Claims Quality Specialist
Company : Catholic Health Initiatives
Location : Bakersfield, CA, 93301
Job Type : Full Time
Salary : 30.91-45.98 HOUR
Date Posted : 1 January 2026
Job Summary and Responsibilities
The Claims Quality Specialist is responsible for ensuring the accuracy and quality of claims processing within a managed care service organization. This role involves auditing claims, identifying errors, and implementing corrective actions to improve overall claims accuracy and efficiency. The Claims Quality Specialist will work closely with the Claims Research colleague and other team members to enhance claims processes and ensure compliance with regulatory standards.
Job Requirements
Minimum Qualifications:
- Minimum of 5 years of experience in claims processing, quality assurance, or a related role within a managed care or healthcare environment.
- Strong knowledge of healthcare claims processing, coding (ICD-10, CPT, HCPCS), and billing practices
- Proficiency in using a managed care and/or claims processing platform.
- High School Diploma or equivalent required
Preferred Qualifications:
- Experience with data analytics tools and software such as SQL, SAS
- Previous experience working directly with healthcare providers or within a provider network setting
- Bachelor’s Degree - Bachelor’s degree in Business, Healthcare Administration, or a related field
The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
One Community. One Mission. One California
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Frequently asked questions
In Bakersfield, certifications like Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) can boost your credibility. These credentials demonstrate mastery in claims coding and quality assurance, aligning well with local healthcare providers' expectations and regulatory demands.
Bakersfield’s demand for claims quality experts is growing moderately due to expanding managed care services. Competition tends to favor candidates with strong analytics and claims processing experience, especially those familiar with ICD-10 and CPT coding in healthcare claims.
Daily hurdles include scrutinizing claims for errors, collaborating with claims research teams to resolve discrepancies, and ensuring compliance with healthcare billing regulations. Staying updated on coding standards like HCPCS is crucial to maintaining claims accuracy and efficiency.
Advancement often leads to roles like Claims Manager or Quality Assurance Analyst, where overseeing teams and refining audit processes become key. Building expertise in data analytics tools like SQL can significantly enhance upward mobility within healthcare administration.
Salaries generally range between $60,000 and $75,000 annually, influenced by experience in claims processing and familiarity with healthcare billing codes. Those with advanced skills in data analytics and provider network experience may command higher compensation.
Catholic Health Initiatives fosters growth through access to cutting-edge claims management systems and ongoing training in healthcare compliance. Employees benefit from a culture emphasizing quality improvement and collaboration within managed care service teams.
At Catholic Health Initiatives, there’s a strong focus on integrating technology with patient-centered care. Specialists here engage deeply with cross-functional teams to innovate claims auditing processes while promoting regulatory adherence and cost containment.
Proficiency in SQL or SAS greatly enhances a specialist’s ability to analyze claims data trends, identify systemic errors, and recommend process improvements. These skills enable more precise audits and support data-driven decision-making within managed care frameworks.
Many believe it’s purely clerical, but the role demands analytical rigor, coding proficiency, and regulatory knowledge. It’s a dynamic position that directly impacts patient care quality, cost control, and compliance in complex healthcare environments.
Handling denied claims involves detailed error identification and communication with providers to resolve discrepancies. The specialist must understand coding intricacies and billing policies to facilitate claim recovery and improve future claim acceptance rates.