144 Results for

Claims Examiner Jobs in Echo Park, CA

Jobs

Brea, CA10 days ago

$43–$48 Per Hour

Responsibilities:Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

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.

New!

West Los Angeles, CA4 days ago

Remote

$175,000–$225,000 Per Year

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. We strongly value a collegial environment and work-life balance, with a billing requirement of 1800 hours annually and remote work flexibility as well as a generous quarterly bonus structure for non-equity partners.

New!

Los Angeles, CA4 days ago

Remote

$185,000–$250,000 Per Year

The Insurance Litigation & Coverage Group carries a national reputation representing domestic and international carriers in coverage disputes, bad faith litigation, and complex multi-insurer matters — from routine coverage questions to the most complex litigation in state and federal courts. Founded over 70 years ago, this California-based firm has built a national reputation representing domestic and international insurance companies across the full spectrum of coverage matters — backed by 90+ attorneys and growing across 7 offices and 27 practice groups.

Los Angeles, CA18 days ago

$43.29–$48.29 Per Hour
Temporary
Contractor
Full-time

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. Minimum of 3 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.

Los Angeles, CA18 days ago

$42.71–$55.53 Per Hour
Temporary
Contractor
Full-time

The Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud & abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste & abuse. 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.

Los Angeles, CA18 days ago

$45–$55.53 Per Hour
Temporary
Contractor
Full-time

This position independently manages full-cycle investigations from intake through closure, develops investigative strategies, prepares evidentiary packages for regulatory or law enforcement referral, and provides clinical and operational insight into healthcare billing patterns and provider behaviors. Strong understanding of coding and reimbursement structures (including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems (HCPCS), International Classification of Diseases (ICD-10)), medical billing, and claims review processes.

New!

Anaheim, CA5 days ago

Full-time

The ideal candidate will excel at collaborating with third-party adjusters, vendors, and industry experts to ensure claims are handled efficiently and accurately while delivering exceptional service to agents and claimants. This role involves overseeing and managing complex property and casualty claims, including those related to building and structural damage, auto, and workers’ compensation.

Irvine, CA30+ 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.

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.

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.

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.

Pasadena, CA14 days ago

$84,240–$126,360 Per Year

This role ensures timely and accurate claims handling in accordance with applicable laws, organizational policies, and insurance coverage requirements, while mitigating financial and reputational risk to the organization. Proven experience in the handling of professional liability, employment liability, and general liability claims, and interacting with medical staff, legal counsel, risk managers, and insurance carriers.

Woodland Hills, CA23 days ago

$68,481.25–$115,489.01 Per Year

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.

Pasadena, California30+ 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.

Woodland Hills, CA24 days ago

$78,000–$107,250 Per Year

This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Manage litigation filed nationwide against insureds; appoint, direct, and manage defense counsel; proactively work toward expeditious and economical resolution of claims; assist internal claims vendor management, disbursement and legal collections teams with defense counsel, bill payment, and collection issues.

Los Angeles, CA30+ days ago

Experience: Three (3) years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting required. Acquires and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information.

Irvine, California20 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.

El Monte, California18 days 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!

Anaheim, CA4 days ago

$60,000–$90,000 Per Year

This position is ideal for an insurance professional with experience handling property and casualty claims who enjoys analytical problem-solving, claim investigations, and working with multiple stakeholders to achieve timely and accurate claim resolution. The Claims Examiner will collaborate with third-party administrators, adjusters, vendors, and technical experts to investigate claims, evaluate coverage, determine liability, and negotiate settlements.

Anaheim, CA30+ 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.

New!

Anaheim, California6 days ago

Pasadena, CA30+ days ago

Remote

Contractor

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.

Woodland Hills, CA30+ days ago

This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders.

Orange, CA24 days ago

Remote

$49–$50 Per Hour

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.

Long Beach, CA19 days ago

$45–$50 Per Hour

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. 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.

Brea, CA11 days ago

$43–$48 Per Hour

CA24 days ago

Remote

$125,000–$145,000 Per Hour

Draft well written and comprehensive captioned reports to request reserve and settlement authority on higher exposure cases that outline all critical aspects of the case in preparation for roundtable presentations to the carrier partners. Supporting the Construct Defect Claims team, you will independently manage moderate to high exposure claims involving alleged defects in residential and commercial construction.

CA10 days ago

$125,000–$145,000 Per Year

Long Beach, CA24 days ago

$45–$50 Per Hour

CA30+ days ago

$55,930.55–$73,828.33 Per Year

Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners. Understanding of Industry pricing methodologies, such as Medicare/Medi-Cal fee schedule, Diagnosis Related Groups (DRG), Multiple Procedure Payment Reduction (MPPR) and benefit interpretation and administration .

MS30+ days ago

Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverages, principles, and laws. Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.

Long Beach, CA30+ days ago

$80,000–$98,000 Per Year

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. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

CA30+ days ago

$60,234–$85,000 Per Year

To analyze workers compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

Long Beach, CA30+ days ago

$80,000–$100,000 Per Year

PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

Glendale, CA30+ days ago

$72,914–$85,000 Per Year

brea, CA30+ days ago

Remote

$85,000–$105,000 Per Year

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. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

West Hills, CA29 days ago

Remote

$80,000–$98,000 Per Year

PRIMARY PURPOSE OF THE ROLE: To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

Long Beach, CA26 days ago

$85,000–$105,000 Per Year

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. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

Brea, CA26 days ago

Remote

$85,000–$105,000 Per Year

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. 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.

Brea, CA, CA11 days ago

Woodland Hills, CA30+ days ago

This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Manage litigation filed nationwide against insureds; appoint, direct and manage defense counsel; proactively work toward expeditious and economical resolution of claims; assist Company claims vendor management, disbursement and legal collections teams with defense counsel, bill payment and collection issues.

Long Beach, CA24 days ago

$45–$50 Per Hour

Brea, CA11 days ago

Remote

$47–$48 Per Hour

Duties: 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. Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Telecommuter, CA12 days ago

$72,914–$95,000 Per Year

Long Beach, CA30+ days ago

$72,914–$90,000 Per Year

Analyzes and processes complex or technically difficult workers compensation claims by investigating and gathering information to determine the exposure on the claim; • Manages claims through well-developed action plans to an appropriate and timely resolution; • Negotiates settlement of claims within designated authority; • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim; • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level; • Prepares necessary state filings within statutory limits; • Manages the litigation process; ensures timely and cost-effective claims resolution; • Coordinates vendor referrals for additional investigation and/or litigation management; • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients; • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets; • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner; • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships; • Ensures claim files are properly documented and claims coding is correct; • Refers cases as appropriate to supervisor and management; • Performs other duties as assigned; • Supports the organizations quality program(s); • Travels as required. 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.

West Hills, CA30+ days ago

Remote

$80,000–$105,000 Per Year

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. Analyzes and processes complex or technically difficult workers compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

CA30+ days ago

Remote

$63,404–$95,000 Per Year

Los Angeles, Montana30+ days ago

Venbrook works across the claims lifecycle with services that include Third Party Administration (TPA), Complex Claims Management, Catastrophe, Independent Adjusting, subrogation recovery, litigation management, investigative, and special investigations unit (SIU) services. Venbrook's team of experts and industry specialists partners with their clients to manage their risks, create security, promote growth, and add value by delivering best-in-class commercial property & casualty, employee benefits, and personal risk insurance products and programs.

Brea, CA10 days ago

Contractor

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. Analyzes and processes complex or technically difficult workers\' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

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Claims Examiner Jobs in Echo Park, CA

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