Claims Auditor Health Source MSOClaims AuditorAlhambra, CAFull timeResponsibilities 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.
Claims Examiner - Workers Compensation (Hourly) IconmaClaims Examiner - Workers Compensation (Hourly)Brea, CA$43–$48 / hourResponsibilities: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.
NewAuto Claims Adjuster - Temp Vaco LLCAuto Claims Adjuster - TempIrwindale, CA$29–$30Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to: the individual’s skill sets, experience and training; licensure and certification requirements; office location and other geographic considerations; other business and organizational needs. With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure.
NewClaims Examiner - Workers Compensation IconmaClaims Examiner - Workers CompensationRancho Cucamonga, CA$45–$50 / hourResponsibilities: 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.
Grievance Resolution Specialist Kinetic Personnel GroupGrievance Resolution SpecialistOrange, CATemporaryGathers pertinent information regarding the grievances and appeals received, including, but not limited to, member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements. The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
NewClaims Salvage Operations Processor AAAClaims Salvage Operations ProcessorCarson, CaliforniaPerforms duties that ensure compliance with government regulations, processes paperwork, issues payments, may answer incoming phone calls and make outbound calls to customers and vendors. Issue payments, collect and process salvage proceeds, checks, DMV refunds and documents, subrogation payments and miscellaneous reimbursements and fees in the appropriate systems.
Claims Specialist - Claims Processing Providence Health & ServicesClaims Specialist - Claims ProcessingAnaheim, CA$24–$33.73 / hourRequsition ID: 429445 Company: Providence Jobs Job Category: Claims Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Admin Support Department: 7520 CLAIMS PROCESSING CA HERITAGE SERVICES Address: CA Anaheim 200 W Center St Promenade Work Location: St Joseph Home Health-Anaheim Workplace Type: On-site Pay Range: $24.00 - $33.73 Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Claims Specialist - Claims Processing Providence St. Joseph HealthClaims Specialist - Claims ProcessingAnaheim, CATogether, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. Required Qualifications: HMO claims processing experience in a managed care environment, preferably PMG/IPA setting within the last 3 years or any combination of education and/or experience which produces an equivalency.
Claims Specialist II - Provider Claims 26-00063 Alura Workforce SolutionsClaims Specialist II - Provider Claims 26-00063Rancho Cucamonga, CAAdditional responsibilities include handling escalated claim-related telephone inquiries, assisting with cross-training as needed, performing complex claim adjustment projects, and processing Provider Disputes in accordance with regulatory requirements. DESCRIPTION The Claims Specialist II – Provider Claims is responsible for fulfilling the technical support needs of appeals and support staff, while ensuring that appeals and call center tasks are conducted consistently and accurately.
Claims Specialist II - Provider Claims 26-00106 Alura Workforce SolutionsClaims Specialist II - Provider Claims 26-00106Rancho Cucamonga, CAAdditional responsibilities include handling escalated claim-related telephone inquiries, assisting with cross-training as needed, performing complex claim adjustment projects, and processing Provider Disputes in accordance with regulatory requirements. DESCRIPTION The Claims Specialist II – Provider Claims is responsible for fulfilling the technical support needs of appeals and support staff, while ensuring that appeals and call center tasks are conducted consistently and accurately.
Claims Specialist II - Provider Claims 26-00130 Alura Workforce SolutionsClaims Specialist II - Provider Claims 26-00130Rancho Cucamonga, CAAdditional responsibilities include handling escalated claim-related telephone inquiries, assisting with cross-training as needed, performing complex claim adjustment projects, and processing Provider Disputes in accordance with regulatory requirements. DESCRIPTION The Claims Specialist II – Provider Claims is responsible for fulfilling the technical support needs of appeals and support staff, while ensuring that appeals and call center tasks are conducted consistently and accurately.
Claims Analyst Clever Care Health Plan IncClaims AnalystHuntington Beach, CA$88,000–$100,000 / yearThe Claims Analyst will work with the Senior Director of Medicare Operations in identifying potential areas for process improvement initiatives to support development of automation, payment accuracy, audit activities, business rules and P&Ps. Utilize and access computer and appropriate software (e.g., Microsoft: Word, Excel, PowerPoint) and job-specific applications/systems (e.g., EZCAP Claims Processing System and Authorization system) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.
Claims Auditor Western GrowersClaims AuditorIrvine, CAThis position reports to the Supervisor of Payment Integrity and performs in-depth audits to ensure existing health (medical/dental) benefit plans of Western Growers Assurance Trust and Pinnacle Claims Management, Inc. clients are in compliance with the respective employers summary plan descriptions. At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management.
NewOperations Specialist, Senior (Medicare Claims) Blue Cross and Blue Shield AssociationOperations Specialist, Senior (Medicare Claims)Long Beach, CAWe are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially.
Sr. Manager - Claims Delegation Audit Astrana Health IncSr. Manager - Claims Delegation AuditMonterey Park, CAThis role will be responsible for the development and execution of department strategies, overall Audit program, Audit process optimization, and management, identifying and leveraging technology and data to improve the quality and minimizing process cost of Claims. Working with the Department Director, Senior Manger will collaborate with other Astrana Health departments and personnel to develop strategies to identify, mitigate and optimize operational and financial gaps.
NewDirector of Claims Impresiv HealthDirector of ClaimsHuntington Beach, CA$130,000–$160,000 / yearThis individual will oversee claims processing, lead high-performing teams, manage vendor relationships, ensure regulatory compliance, and partner across the organization to optimize claims performance, payment integrity, and member and provider satisfaction. The Director of Claims will provide strategic leadership for all Medicare Advantage claims operations, ensuring accurate, timely, and compliant claims adjudication while driving operational excellence.
Claims Specialist II Mercury Insurance Services, LLCClaims Specialist IICalifornia$44,466–$77,881 / yearBodily Injury Claims Management : Analyze medical records to evaluate, negotiate, and settle moderate bodily injury claims with legal counsel for represented claimants and unrepresented parties. If you’re passionate about helping people restore their lives when the unexpected happens, and providing high-quality customer experiences, then our Mercury Insurance Claims team could be the place for you!
Business Analyst Sr, Claims - Covered California CalOptimaBusiness Analyst Sr, Claims - Covered CaliforniaOrange, CA$77,863–$124,581 / yearWe are hoping you will join us as a Business Analyst Sr, Claims - 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. Provides analytical support and technical expertise to executives, directors and staff by delivering insights on Covered California performance, trends and compliance, while partnering with department leadership and internal teams to identify and implement process improvements that enhance efficiency and compliance in claims operations.
Associate Bond Claims Attorney HCC Service CompanyAssociate Bond Claims AttorneySanta Ana, CaliforniaAs an insurance company, however, we must comply with certain Federal and state laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e)), which limits our ability to employ individuals with certain types of criminal convictions. After making a conditional offer and running a background check, if the Company is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction or challenge the accuracy of the background report.
NewClaims Administrator - US Domestic & GeneralClaims Administrator - USNorwalk, CaliforniaRemoteAs a Claims Administrator, you’ll be the key point of contact between our customers and our service partners, ensuring extended warranty claims are handled quickly, accurately, and with empathy. Provide occasional backup support to our Contact Center teams across general warranty inquiries, claims, credits, sales, and product registration.
NewWorkers 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 Auditor 26-00102 Alura Workforce SolutionsClaims Auditor 26-00102Rancho Cucamonga, CA3. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines. DESCRIPTION Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.
Claims Coordinator RiversideClaims CoordinatorRiverside, CaliforniaAs the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call.
Commercial Rideshare Non-Injury Claims Adjuster - Weekend Farmers Group, Inc.Commercial Rideshare Non-Injury Claims Adjuster - WeekendCARemote$27.73–$47.07 / hourProactively investigates and determines coverage for Auto policy claims with coverage issues requiring in-depth investigation including but not limited to if the policy out of force for the date of loss, unlisted or permissive drivers, excluded drivers, vehicle not on the policy, rideshare involvement, material misrepresentation issues, and new business investigations. Utilizes a broad understanding of claims adjusting to apply skills and knowledge to investigate and determine liability for claims with basic coverage issues and moderate to complex liability issues; performs in-depth investigation and analysis on losses such as multi vehicle losses with comparative negligence.
Claims Resolution Specialist CalOptimaClaims Resolution SpecialistOrange, CA$53,813–$80,720 / yearWe are hoping you will join us as a Claims Resolution Specialist 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. Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.
Claims Coordinator ServiceMaster Restore 9430 - RiversideClaims CoordinatorRiverside, CAAs the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call .
Claims Specialist Elite SourcingClaims SpecialistCosta Mesa, CaliforniaYou will be responsible for investigating and evaluating property damage claims arising from automobile accidents, working closely with the demands team and clients to ensure fair compensation for damages. Investigate property damage claims involving auto accidents, including reviewing police reports, witness statements, and damage assessments.
Claims Auditor 26-00128 Alura Workforce SolutionsClaims Auditor 26-00128Rancho Cucamonga, CA3. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines. DESCRIPTION Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.
Sr. Claims Resolution Analyst SHPCA SCAN Health PlanSr. Claims Resolution AnalystLong Beach, CaliforniaHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models.
Vice President of Health Plan Operations and Claims Prime Healthcare Management IncVice President of Health Plan Operations and ClaimsOntario, California$150,000–$250,000 / yearFull timeThe VP of Health Plan Operations and Claims will provide strategic leadership and development of the Claims Department and its employees, as well as collaborate with Network Development, Provider Affiliation and Member Relations, Contracting, and Benefits Administration to ensure data integrity and to drive financial and operational value across Employee Health Plans to maximize benefit coverage while containing cost. As you would expect, this role has many facets including Health Plan Operations, Health Performance Metrics, Cost Reduction, Market Forces, Quality and Delivery of Care, Regulatory Reforms, Strategy and Operating Models, Long Term Business Objectives, Healthcare Payers, Claim Operations Strategies, Claim Process Automation, Self-Funded Plans, and Employee Health Plans.
Sr. Manager - Claims Delegation Audit Astrana Health, Inc.Sr. Manager - Claims Delegation AuditMonterey Park, California$125,000–$140,000 / yearThe position alongside the leadership team will contribute to driving strategic planning, operational excellence, and accuracy of the claims process and ensure compliance with regulations and contract requirements for Medicare, Commercial Exchange, and Medicaid service lines. External Audit planning, execution & support Own the end‑to‑end strategy and execution of all external audits (e.g., CMS, DMHC, health plan audits), ensuring readiness, successful delivery, and continuous score improvement.
Claims Coordinator, PSA Collaborative SolutionsClaims Coordinator, PSASanta Ana, CaliforniaOur services span collectible trading cards, autographs, comic books, coins, video games, event tickets, and memorabilia. We grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions.
Claims Recovery Representative II SchoolsFirst Federal Credit UnionClaims Recovery Representative IITustin, CA$24.56–$35.62 / hourAt SchoolsFirst FCU we are dedicated to building and growing a diverse, inclusive, and authentic Dream Team, so if you're excited about a position or wanting to make a career change but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. Responsible for assisting and completing basic debit and credit card investigations, including fraud, and/or reviewing basic cardholder claim reports in order to take appropriate action to mitigate loss to the organization.
Medicare Claims Clever Care Health Plan IncMedicare ClaimsHuntington Beach, CA$80,000–$90,000 / year5% - Facilitates and creates a team environment within the unit and with other departments; runs regular unit meetings, attends monthly claims review meetings and/or Clever Care meetings, as appropriate, in order to ensure effective communication between team members and disciplines. Skills: Ability to attend insurance and industry/business functions to promote and present a positive image of Clever Care; ability to participate in presentations to newly contracted providers; ability to travel as necessitated by business needs.
Claims Auto Adjuster AAAClaims Auto AdjusterCosta Mesa, CaliforniaThis entry-level position supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of material damage, property damage, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
Claims Senior Auto Adjuster AAAClaims Senior Auto AdjusterRiverside, CaliforniaThe Claims Senior Auto Adjuster supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of material damage, property damage, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
NewClaims Service Representative - Total Salvage AAAClaims Service Representative - Total SalvageCarson, CaliforniaThis entry level position supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
Claims Examiner - Workers Compensation (Hourly) ICONMA, LLCClaims Examiner - Workers Compensation (Hourly)Brea, CA$43–$48 / hourResponsibilities: 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.
Claims Senior Casualty Adjuster AAAClaims Senior Casualty AdjusterDiamond Bar, CaliforniaThe Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
Senior Claims Manager, Remote - CA Workers'''' Compensation Great American Insurance CompanySenior Claims Manager, Remote - CA Workers'''' CompensationCARemote$135,000–$145,000 / yeargain buy-in from our insureds regarding the direction each claim is taking, develop a strategy of how to best mitigate the potential loss through interaction with the claimant, and making sure that light duty jobs are available for quick return to work. We need someone who has the ability to help and direct when needed, a group of strong, carefully chosen senior level adjusters to: focus on fresh, creative, and quick approaches on every claim resulting in proactive claim resolutions.
Senior Claims Examiner W. R. Berkley CorpSenior Claims ExaminerIrvine, CA$110,000–$125,000 / yearThis 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.
Claims Examiner - Workers Compensation eTeam Inc.Claims Examiner - Workers CompensationBrea, CARemote$45–$48 / 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.
Workers Compensation Claims Consultant, West CNA Financial CorpWorkers Compensation Claims Consultant, WestBrea, CA$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages. Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements.
Claims Consultant - Unsupported Excess CNA Financial CorpClaims Consultant - Unsupported ExcessCA$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages. Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements.
Commercial Auto & General Liability Claims Consultant CNA Financial CorpCommercial Auto & General Liability Claims ConsultantCA$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages. Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements.
Claims Account Manager II (Northern California) ICW GroupClaims Account Manager II (Northern California)CARemote$90,559.93–$152,723.07 / yearHeadquartered 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. Identifies service levels of each account and balances Claims Account Manager staffing/ratio, in conjunction with the Customer Relations Manager, to ensure claim service meets our brand level.
Associate Bond Claims Litigation Representative HCC Service CompanyAssociate Bond Claims Litigation RepresentativeSanta Ana, CaliforniaTokio Marine HCC – Surety Group, a member of the Tokio Marine Group of Companies, has an opportunity for Associate Bond Claims Litigation Representative at our Santa Ana, CA branch office. Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment.
Claims Examiner - Workers Compensation ICONMA, LLCClaims Examiner - Workers CompensationLong Beach, CA$45–$50 / hourMental: 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.
Senior Claims Specialist Your Next CareerSenior Claims SpecialistSanta Fe Springs, CaliforniaEnsure the timely logging of all new claims (delegate to Claims Assistant if necessary) and timely reporting to our Insurance Carrier, with guidance by the Dir of Risk Management. Recognized as the 2026 “Top Hispanic Supermarket in the U.S.” by Abasto, we are committed to serving our customers, supporting our communities, and creating growth opportunities for our team members.