NewClaims Examiner/Senior Claims Examiner BerkleyClaims Examiner/Senior Claims ExaminerWalnut Creek, California$80,000–$125,000 / yearIn these roles, you will be responsible for the analysis and management of moderate to complex workers’ compensation claims, including reviewing, investigating, and making determinations around coverage, compensability, and claim appropriateness. Success in this role requires strong judgment, consistent performance, and a high level of competency in negotiating settlements, managing subrogation, and delivering sound, compliant outcomes.
Workers Compensation Claims Examiner (California Jurisdiction) EliteWorkers Compensation Claims Examiner (California Jurisdiction)Los Angeles, CaliforniaThe 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).
Claims Examiner I Western GrowersClaims Examiner IFresno, CA$40,580.28–$52,756.02 / yearAdjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, Blue Card, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, by calculating benefit due to approve or deny, based on SPD and within accepted corporate cycle timeframe. Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and electronic claims per state, federal, and health plan regulatory requirements and department guidelines, as well as meeting established quality and production performance benchmarks, including research and review of applicable documentation.
Claims Examiner I (50480) Western GrowersClaims Examiner I (50480)Fresno, CAAdjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, Blue Card, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, by calculating benefit due to approve or deny, based on SPD and within accepted corporate cycle timeframe. Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and electronic claims per state, federal, and health plan regulatory requirements and department guidelines, as well as meeting established quality and production performance benchmarks, including research and review of applicable documentation.
Workers Compensation Claims Examiner TEEMA GroupWorkers Compensation Claims ExaminerChino, CA$93,000–$104,000This 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.
Claims Examiner CalOptimaClaims ExaminerOrange, CA$47,840–$64,584 / yearAnalyzes and validates Medi-Cal pricing; researches, adjusts and adjudicates claims; reviews services for accurate charges and utilizes current billing code sets, including International Classification Diseases (ICD10) codes, Current Procedural Terminology (CPT) codes and/or authorization guidelines as reference. We are hoping you will join us as a Claims Examiner and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders.
Claims Examiner - Lead Covered California CalOptimaClaims Examiner - Lead Covered CaliforniaOrange, CA$55,966–$83,949 / yearWe are hoping you will join us as a Claims Examiner - Lead Covered California and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Claims Examiner - Lead CalOptimaClaims Examiner - LeadOrange, CA$55,966–$83,949 / yearWe are hoping you will join us as a Claims Examiner - Lead and help shape the future of healthcare where you'll be an integral part of our CLA - Claims Production team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Worker Compensation Claims Examiner III (Hybrid) Roth Staffing CompaniesWorker Compensation Claims Examiner III (Hybrid)Fresno, California$35–$44 / hourThe Claims Examiner III works closely with claimants, attorneys, medical providers, nurse case managers, vocational experts, vendors, clients, and internal staff to ensure claims are handled in compliance with state regulations and company best practices. This role is responsible for managing complex and litigated workers' compensation indemnity claims from assignment through resolution.
Senior Workers' Compensation Claims Examiner (FULL Remote - Contract) - CA Johnson Service GroupSenior Workers' Compensation Claims Examiner (FULL Remote - Contract) - CAConcord, CARemote$50.25–$55.89 / hourThe 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) .
Senior Workers' Compensation Claims Examiner (FULL Remote - Perm) - CA Johnson Service GroupSenior Workers' Compensation Claims Examiner (FULL Remote - Perm) - CAConcord, CARemote$98,000–$109,000 / yearThe 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).
Senior Claims Examiner - Transportation Athens AdministratorsSenior Claims Examiner - TransportationSacramento, CaliforniaATHENS POSITION DETAILS Position Title: Senior Claims Examiner Department: Workers’ Compensation California Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 12 Career Ladder: Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. POSITION SUMMARY Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our workers compensation offices and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday – Thursday.
CLAIMS EXAMINER I MSO North East Medical ServiceCLAIMS EXAMINER I MSOBurlingame, CAESSENTIAL JOB FUNCTIONS: Perform the daily examination, auditing and adjudication activities to submitted professional claims based on established utilization criteria, Medi-Cal and/or Medicare guidelines, member's Evidence of Benefit, and policies and procedures outlined in the MSO Claims Manual. Working knowledge of managed care and/or healthcare claim reimbursement or medical billing in Medi-Cal and Medicare Advantage program preferred.
Claims Examiner - Workers Compensation eTeam Inc.Claims Examiner - Workers CompensationOntario, CARemote$50–$55 / hourPRIMARY 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.
Indemnity Claims Examiner- Workers' Compensation (Open) KERN COUNTY SUPERINTENDENT OF SCHOOLSIndemnity Claims Examiner- Workers' Compensation (Open)Bakersfield, CA$7,173–$8,683Experience: Three (3) years of Workers' Compensation claims adjusting experience, preferably in a self-insurance operation, to include processing claims from inception of injury through litigation to closure. Education: Equivalent to the completion of the twelfth grade, supplemented by coursework and training in business office practices, workers compensation insurance matters, or closely related fields.
NewIndemnity Claims Examiner- Workers' Compensation (Fresno/Clovis, CA) (Open) KERN COUNTY SUPERINTENDENT OF SCHOOLSIndemnity Claims Examiner- Workers' Compensation (Fresno/Clovis, CA) (Open)Bakersfield, CA$7,388–$8,943Experience: Three (3) years of Workers' Compensation claims adjusting experience, preferably in a self-insurance operation, to include processing claims from inception of injury through litigation to closure. Education: Equivalent to the completion of the twelfth grade, supplemented by coursework and training in business office practices, workers compensation insurance matters, or closely related fields.
NewIndemnity Claims Examiner- Workers' Compensation (Sacramento, CA) (Open) KERN COUNTY SUPERINTENDENT OF SCHOOLSIndemnity Claims Examiner- Workers' Compensation (Sacramento, CA) (Open)Bakersfield, CA$7,388–$8,943Experience: Three (3) years of Workers' Compensation claims adjusting experience, preferably in a self-insurance operation, to include processing claims from inception of injury through litigation to closure. Education: Equivalent to the completion of the twelfth grade, supplemented by coursework and training in business office practices, workers compensation insurance matters, or closely related fields.
Claims Examiner - Workers Compensation (Hourly) eTeam Inc.Claims Examiner - Workers Compensation (Hourly)Brea, CARemote$45–$48.57 / hourPRIMARY 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. Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
Claims Examiner MedPOINT ManagementClaims ExaminerSherman Oaks, CARemoteFull timeMedPOINT Management is a leading Independent Physician Association (IPA) management company based in Sherman Oaks, CA, dedicated to delivering high-quality healthcare administrative services. We foster a collaborative and supportive work environment where employees are empowered to grow and make a meaningful impact in the healthcare industry.
Claims Examiner I Tokio Marine HCCClaims Examiner IEncino, CaliforniaThe Company will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e))(the “VCCLEA”), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. As an insurance company, we comply with certain federal, state and local laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e)), which restricts our ability to employ individuals with certain types of criminal convictions.