177 Results for

Claims Analyst Jobs in California

Jobs

New!

Los Angeles, CA3 days ago

$75–$90 Per Hour

Candidates should have 3-5 years of build experience in Epic Tapestry (Specifically: Benefits Engine for Tapestry, Tapestry Accounts Payable Administration, Tapestry Claims Administration, Tapestry Contracts Administration); additionally prefer candidates with advanced excel experience and sequel). Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal.

New!

Orange, CA6 days ago

$45–$50 Per Hour

Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.

Alhambra, CA30+ days ago

Full-time
Employee

Responsibilities include, but not limited to: Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including:Contractual agreement rates. Job Description: Claims Auditor will be responsible for auditing claims processed by Claims Examiners.

Santa Clara,, California10 days ago

Contractor

The specific compensation for this position will be determined by several factors, including the scope, complexity, and location of the role, as well as the cost of labor in the market; the skills, education, training, credentials, and experience of the candidate; and other conditions of employment. Successfully placed or hired candidates would only be asked for banking details after accepting an offer from us during our official onboarding processes as part of payroll setup.

Cupertino,, California10 days ago

$55–$60 Per Hour
Contractor

The specific compensation for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Successfully placed or hired candidates would only be asked for banking details after accepting an offer from us during our official onboarding processes as part of payroll setup.

Irvine, California10 days ago

$130,000–$150,000 Per Year

Santa Clara,, California10 days ago

$80–$85 Per Hour
Contractor

The specific compensation for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. The ideal candidate will play a critical role in analyzing, designing, and implementing SAP solutions to optimize business operations and support revenue generation.

New!

Aliso Viejo, CA2 days ago

$40–$45 Per Hour

This role is critical in validating, certifying, and ensuring high-quality data as part of a unified data fabric migration into Snowflake. You will play a key role in ensuring data integrity, supporting analytics, and enabling accurate reporting for business stakeholders.

New!

Los Angeles, CA1 day ago

$32.30–$41.99 Per Hour
Temporary
Contractor
Full-time

Uses knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability, reimbursement methodologies, and relevant laws to find suspicious patterns in claims data, provider enrollment data, and other sources. After making a conditional offer and running a background check, if we are concerned about conviction that is directly related to the job, applicants will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

New!

Los Angeles, CAToday

$24–$30 Per Hour
Temporary
Contractor
Full-time

Auditor: Knowledge of HMO/IPA operations; medical terminology; ICD-10, RVS, and CPT coding; Medicare and Medi-Cal guidelines; and 10-key skills by touch. WinCorp Solutions is seeking multiple healthcare roles to serve as a consultant for our clients in the healthcare system.

Orange, CA10 days ago

$24–$30 Per Hour
Temporary

Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment. Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.

Pasadena, California30+ days ago

$24–$28 Per Hour

Communicate professionally with members and providers to resolve inquiries, follow up on pended claims, and complete corrections or adjustments. This position is ideal for someone who enjoys problem‑solving, working with complex benefit plans, and collaborating with both internal teams and external partners.

San Mateo, California24 days ago

$75–$85 Per Hour

This role will play a critical part in designing, building, testing, and deploying HB and claims workflows, ensuring accurate billing, compliance, and efficient revenue cycle operations. About Us: CTG, a Cegeka company, delivers IT and business solutions that enhance clients’ digital agility, empowering them to seize new opportunities and overcome any challenge.

New!

Sacramento, CA2 days ago

$45.60–$68.40 Per Hour

Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Ensures timely resolution of problems, ensures customers are informed of unresolved issues, and engages other analysts directly to resolve challenging issues.

Orange, California30+ days ago

Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

Sherman Oaks, CA30+ days ago

The reporting coordinator is responsible for ensuring accurate, timely, and efficient reporting and input of data related to all claim functions. · Prepares universe reports for health plan audits, Monthly Timeliness Reports, Medicare reporting and other Health Plan or regulatory requests.

New!

San Mateo, California3 days ago

$75–$85 Per Hour

Description: CTG is seeking a certified Epic Professional Billing (PB) Claims Build Analyst with 3+ years of hands-on build experience to support the design, configuration, and optimization of Epic billing and claims workflows. About Us: CTG, a Cegeka company, delivers IT and business solutions that enhance clients’ digital agility, empowering them to seize new opportunities and overcome any challenge.

Los Angeles, CA30+ days ago

$190,000–$269,000 Per Year

Documents, reviews, and analyzes schedules, contracts, change orders, correspondence, daily reports, meeting minutes, monthly reports, and any additional documents related to the project/file . The annual allocation to the ESOP is fully funded by BDO through investments in company stock and grants employees the chance to grow their wealth over time as their shares vest and grow in value with the firm’s success, with no employee contributions.

Los Angeles, CA30+ days ago

The Claims Processor will provide excellent client service by accurately processing provider claims in a timely manner while adhering to the contractual requirements of the California Department of Education and LA County Department of Public Social Services as well as Crystal Stairs, Inc. policies and procedures. An AA/AS Degree in Accounting, Business, or Human Services preferred/or a minimum of two years of verifiable college coursework with a focus on accounting or business; verifiable work experience may be substituted for college level education.

Riverside, CA30+ days ago

Full-time

Ability to: Accurately gather, record, and evaluate data necessary for determining Restitution Fund benefits; review police reports and medical reports to extract pertinent information; learn, interpret, and apply policies and regulations of the State Board of Control Restitution Fund; organize work and maintain systematic, detailed, and accurate records; make basic arithmetical computations; identify problems requiring referral to other department staff; maintain effective working relationships with others. Experience: Three years of clerical experience which must have included either (1) At least one year in a medical setting which involved working with medical terminology (completion of 6 semester or 9 quarter units of coursework in medical terminology may be substituted for six months of the required specialized experience in a medical setting); * Proof of education must be uploaded with application, if using for consideration.

Anaheim, CA22 days ago

$60,000–$100,000 Per Year

Our client, a large and growing insurance carrier, is seeking a Third Party Liability Claims Examiner to manage complex bodily injury, property damage, and litigated liability claims related to commercial trucking and business insurance policies. This role is responsible for investigating, evaluating, negotiating, and resolving third-party liability claims while coordinating with attorneys, TPAs, claimants, and internal teams.

Pasadena, California28 days ago

$26–$29 Per Hour

We are seeking an experienced Medical Claims Examiner to review, analyze, and adjudicate medical claims for accuracy, compliance, and medical necessity. Identify coding discrepancies, overpayments, and potential fraud or abuse.

New!

El Monte, California1 day ago

$25–$28 Per Hour

Research and resolve claim discrepancies, including making payment corrections, recovering overpayments, and reprocessing claims as needed. Evaluate claims for potential fraud, waste, abuse, Workers' Compensation, hospital-acquired conditions, and third-party liability; escalate issues appropriately.

New!

Chino, CA4 days ago

$93,000–$104,000

This role requires strong technical expertise, sound judgment, and the ability to handle highly complex indemnity claims within established authority limits. This is a highly interactive role requiring regular communication with clients, claimants, attorneys, medical providers, and internal stakeholders.

San Francisco, CA30+ days ago

Full-time

The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Fairfield, California30+ days ago

$30.38–$36.46 Per Hour

Follows established Partnership policies and procedures, Partnership Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims. The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform.

Rancho Cucamonga, CA30+ days ago

REQUIREMENTSTwo (2) years of experience as a Data Entry Processor Data Entry Processor experience preferably in an HMO or Managed Care setting. This includes validating member coverage, clearing system edits and categorizing a claim type to ensure the claim routes to the appropriate workgroup for adjudication.

Sherman Oaks, CA30+ days ago

Remote

Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration. Researches, reviews and contacts provider services for problem claims and issues, as needed.

Sherman Oaks, CA30+ days ago

Remote

Adhere to MedPOINT Management’s core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration. Researches, reviews and contacts provider services for problem claims and issues, as needed.

Redding, CA16 days ago

We are seeking a detail-oriented Warranty Claims Processor which is responsible for the successful submission of warranty claims to include pre-approval, proof of purchase, extended warranty, and any documentation for successful claims. · Prolonged Sitting: This role involves extensive periods of sitting at a desk and working on a computer (up to 8 hours).

New!

Irvine, California3 days ago

$110,000–$125,000 Per Year

This role actively supports and participates in the company’s culture of continuous learning and innovation, including engagement in innovation groups focused on identifying opportunities for process improvement, enhancement, and transformational change. Key functions include but are not limited to: Adjust all aspects of complex claims and loss notices, including coverage and compensability analysis, reserve setting, reinsurance reporting, and coverage litigation.

Pasadena, CA22 days ago

Remote

Contractor

Primary purpose: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

Concord, CA30+ days ago

Remote

$50.25–$55.89 Per Hour

The Senior Claims Examiner will adjust workers compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f) .

Brea, CA30+ days ago

Full-time

Job Description: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Requirements: California WC claims knowledge SIP certificate Min.

El Monte, California30+ days ago

$23–$29 Per Hour

Interact professionally with members and providers to resolve inquiries, follow up on pended claims, and complete corrections and adjustments. Review claims for fraud, waste, abuse, hospital‑acquired conditions, Workers' Compensation, and Third‑Party Liability, referring cases as appropriate.

Rancho Cordova, California30+ days ago

Remote

The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. Behaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.

Rancho Cordova, California30+ days ago

Remote

$75,000–$105,000 Per Year

Sacramento, California30+ days ago

Remote

Torrance, California30+ days ago

Remote

Sherman Oaks, CA30+ days ago

Remote

Summary: A Hospital Claims Auditor is responsible for the overall quality of claims processes as well as compliance, in accordance with outside regulations and the contractual obligations of the Health Plans and/or Hospital Clients. Knowledge, Skills and Abilities Required: · Strong organizational, analytical and oral/ written communication (English) skills required.

Pleasant Hill, CA16 days ago

Remote

$98,000–$103,500 Per Year

The Senior Claims Examiner will adjust police and fire 4850 workers compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.

Pleasant Hill, CA30+ days ago

Remote

$98,000–$103,500 Per Year

Riverside, California22 days ago

Remote

$75,000–$105,000 Per Year

The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. How you'll make an impact: In this role, you’ll ensure reinsurance and excess carriers receive timely and accurate reports, while working closely with managers and supervisors to address inquiries and maintain quality control.

New!

San Jose, California1 day ago

Remote

Fairfield, California30+ days ago

$32.51–$39.01 Per Hour

Maintain current knowledge of Partnerhsip Claims Policy and Procedures for all lines of business, Medi-Cal Provider Manual, Title 22 regulations, Knox Keene regulations, and CMS Medicare regulations. Overview: Train examiner and customer service level I staff on all related claim types for all Partnership lines of business using AMISYS Advance system and Claims Operating Instruction Memorandums.

Anaheim, CA30+ days ago

Full-time

In this role, you will handle claims involving third-party liability, specifically in commercial trucking and business policies, working to resolve them efficiently while ensuring fair settlements. Key Responsibilities: Investigate, evaluate, and resolve third-party claims including bodily injury, property damage, and liability claims including ones in litigation for commercial trucking and business policies.

Brea, CA30+ days ago

Full-time

Work within established authority on moderate-to-difficult claims, reviewing coverages, determining liability/compensability, collecting statements and essential information, and settling claims using best practices. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.

New!

Irvine, California2 days ago

$44–$54 Per Hour

Responsibilities: Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives, claimants or injured workers, witnesses and producers. Depending on the type of claim may:Communicate with internal Managed Care and Medical resources to ensure coordination with Medical providers on the development and authorization of appropriate treatment plans as well as accurate billing.

Brea, CA21 days ago

$0–$0.01 Per Hour

Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements. Duties:Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.

Brea, CA30+ days ago

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Claims Analyst Jobs in California

Epic Certified Tapestry Analyst Jobot

Claims Examiner - Workers Compensation Iconma

Claims Auditor Health Source MSO

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OPD Product Manager Analyst Pinnacle Technical Resources

Principal Functional Analyst - OVC Pinnacle Technical Resources

SAP Business Systems Analyst Quote to Revenue Pinnacle Technical Resources

Data Analyst - Snowflake (Hybrid) Axelon

SIU Investigative Analyst III Solugenix Corp

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Customer Service Rep - Bilingual Spanish Kinetic Personnel Group

Health Claims Examiner Ultimate Staffing Services

Epic HB/HB Claims Analyst Computer Task Group, Inc

Epic Support Analyst III, Resolute HB PB Claims and Remittance Sutter Health

Pharmacy Claims Analyst - Pharmacy Admin - FT Day Shift University of California, Irvine

Claims Reporting Coordinator MedPOINT Management

Epic PB Claims Computer Task Group, Inc

Director, Forensics - Building Property Claims Recovery bdo consulting

Claims Processor Crystal Stairs

Victim/Witness Claims Technician County of Riverside

Third Party Liability Claims Examiner - Insurance Carrier - Base Salary to 100k/year - Anaheim, CA AllSearch Professional Staffing

Medical Claims Examiner Ultimate Staffing Services

Healthcare Claims Examiner Ultimate Staffing Services

Workers Compensation Claims Examiner TEEMA Group

Customer Service Claims Processor Zenith American Solutions

Claims Examiner II Partnership HealthPlan of California

Claims Processor I Alura Workforce Solutions

Claims Examiner MedPOINT Management

Hospital Claims Examiner MedPOINT Management

WARRANTY CLAIMS PROCESSOR Carmona's Appliance Center

Senior Claims Examiner Berkley

Claims Examiner - Workers Compensation Apidel Technologies

Senior Workers' Compensation Claims Examiner (FULL Remote - Contract) - CA Johnson Service Group

Claims Examiner LanceSoft Inc

Healthcare Claims Adjuster Ultimate Staffing Services

Claims Examiner - Workers' Compensation Gallagher

Senior Claims Examiner - Workers' Compensation Gallagher

Senior Claims Examiner Gallagher

Senior Claims Examiner – Workers' Compensation Gallagher

Hospital Claims Auditor MedPOINT Management

Sr Examiner - 4850 Workers' Compensation Claims (Full Remote - Northern CA)(Perm) Johnson Service Group

Sr Examiner - 4850 Workers' Compensation Claims (Full Remote - Southern CA)(Perm) Johnson Service Group

Reinsurance Claims Examiner Gallagher

Senior Claims Examiner - Complex General Liability Gallagher

Claims Trainer Partnership HealthPlan of California

3rd Party Claims Adjuster/Examiner - HYBRID DB Insurance Co., Ltd.

Sr Claim Examiner-WC (CA) Crawford & Company

Senior Claim Examiner I, CA AmTrust Financial Services, Inc.

Claim Examiner- WC TPI Global Solutions

Sr Claim Examiner- WC TPI Global (formerly Tech Providers, Inc.)

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