Job Description:
Leveraging strong analytical and problem-solving skills, you investigate complex inquiries, develop accurate and timely responses, and serve as a trusted resource for claims research and provider support. This position requires exceptional written and verbal communication skills, sound judgment, attention to detail, and the ability to work independently while collaborating across multiple functional areas. Role and Responsibities: Analyze, research, and resolve routine to complex inquiries related to claims, provider concerns, program policies, business processes, and operational procedures, utilizing subject matter expertise, independent judgment, and established resources to determine appropriate resolutions or escalations. Manage claims research, stakeholder inquiries, and correspondence workflows by creating, reviewing, and distributing professional communications; monitoring case progress; prioritizing assignments; and ensuring timely, accurate, and compliant responses through resolution. Collaborate with providers, clients, leadership, and cross-functional teams to resolve issues, support program initiatives, facilitate escalations, and ensure consistent application of organizational policies, procedures, and regulatory requirements. Maintain and enhance operational effectiveness by contributing to shared knowledge resources, documenting complex issue resolution, identifying process improvement opportunities, and recommending solutions that improve efficiency, service delivery, and customer outcomes. Support organizational excellence through training, mentoring, and knowledge- sharing activities while interpreting and applying federal, state, client, and organizational regulations to ensure compliance and minimize operational risk.
Requirements:
Minimum of three years of experience in healthcare operations, claims processing, provider support, customer service, business process outsourcing, research, or a related field, with Medi-Cal experience preferred. Strong analytical, problem-solving, and organizational skills, with the ability to research complex issues, develop effective solutions, manage multiple priorities, and perform successfully in a fast-paced environment. Excellent written, verbal, and interpersonal communication skills, including experience collaborating with providers, clients, internal business partners, and cross-functional teams, and the ability to tailor communications to diverse audiences. Working knowledge of provider operations, claims processing, and customer support practices, along with proficiency in Microsoft Office applications and business systems used to research, track, and resolve inquiries. Experience working with business processes. Ability to assess clients business and identify improvement opportunities.
Benefits:
Our Benefits Include: Medical, Dental, and Vision Insurance 401(k) Retirement Plan Health Savings Account (HSA) Disability Insurance (Short-Term and Long-Term) Life and AD&D Insurance Paid Sick Leave (where required by applicable state or local law) Supplemental Insurance Plans Identity Theft Protection Pet Insurance Employee Wellness Programs Employee Assistance Program (EAP) Career Growth and Professional Development Opportunities Disclaimer: Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Systems Inc. reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws. About Cynet Systems Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading technology staffing and workforce solutions company serving Fortune 500 companies, government agencies, and enterprise organizations across the United States and Canada. We deliver agile, scalable talent solutions across IT, engineering, life sciences, clinical, and professional staffing, powered by a high-performing recruitment engine operating across North America and Asia. As a nationally and locally certified Minority Business Enterprise (MBE), Cynet Systems is committed to helping organizations build high-performing teams while empowering professionals to grow rewarding careers. Our organization is certified to ISO 9001, ISO 14001, ISO 27001, and SOC 2 Type II standards, reflecting our commitment to quality, security, operational excellence, and customer success.
