Top 18 Claims processor Jobs in California

Healthcare Claim Processor
Qualfon —California
- $24 an hour
- Full-time
- Remote
- HIPAA
- Research
- Mid-level
3d
Part-Time Mail Processor
Athens Administrators —Orange, CA
- $23.59 - $24.88 an hour
- Part-time
- Bachelor of Science
- Research
- Office
- On-the-job training
- Employee assistance program
Quick Apply
5d
Junior Claims Processor
Southern California Pipe Trades Administrative Corporation —Los Angeles, CA
- $28.00 - $34.74 an hour
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Lead Claims Specialist - Claims Processing
Providence —Mission Hills, CA
- $27.92 - $42.73 an hour
- Full-time
- Hybrid work
- Office
- Fair chance
- Senior level
- Paid parental leave
- Paid holidays
Payment / Check Processor
Crystal Stairs —Los Angeles, CA
- $20 - $25 an hour
- Full-time
- Research
- Mid-level
- Office
- AD&D insurance
- Paid holidays
Quick Apply
Medical Equipment Processor (MEP) – San Leandro, CA
Solventum —San Leandro, CA
- $46,960 - $64,570 a year
- Extended hours
- Mid-level
- High school diploma or GED
- Analysis skills
- Health savings account
- Disability insurance
13d
Title Express Processor (In-Office)
Copart —Vallejo, CA
- $21 an hour
- Overtime
- Basic math
- Office
- Windows
- AD&D insurance
- Employee stock purchase plan
Quick Apply
9d
Claims Processor 3
Zenith-American —San Francisco, CA
- $27.81 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Typing
- Health insurance
- Dental insurance
Central Processing Specialist I/II
WESTAMERICA BANK —Fairfield, CA
- $16.90 - $20.77 an hour
- Full-time
- Word processing
- Computer literacy
- Research
Quick Apply
Claims Processor 1
Zenith-American —San Francisco, CA
- $25.75 an hour
- Full-time
- Computer literacy
- Writing skills
- Basic math
- AD&D insurance
- Health insurance
Sales Order Processor
Navien, Inc. —Irvine, CA
- $23 - $24 an hour
- Full-time
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Health insurance
Service Fulfillment Processor
OneUnited Bank —Los Angeles, CA
- $20.50 - $22.50 an hour
- Word processing
- Research
- Office
AM-Warehouse Returns Processor
Living Spaces —Colton, CA
- $17.40 - $22.60 an hour
- Weekends as needed
- Computer literacy
- Research
- High school diploma or GED
- Paid holidays
- Employee assistance program
Quick Apply

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Inland Empire Health Plan —Rancho Cucamonga, CA
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12d

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Healthcare Claim Processor

Qualfon -
California

Apply Now

Job Details

Full-time
$24 an hour
3 days ago

Qualifications

Regulatory compliance in claims processing
Medical coding guidelines
Medical claims processing software
Healthcare privacy protection
Health information regulatory compliance
Medicaid regulations
Medicaid
Health information management
Productivity software
Medical terminology

Full Job Description

Overview:

Who We Are:

Qualfon is a global provider of omnichannel customer experience and business support solutions. From call center support to lead generation to ecommerce fulfillment, we support our clients and their customers throughout the customer journey.

Our mission is to help as many people as possible pursue their total vocation - as individuals and as members of society by creating an ever-growing number of job opportunities as we strive to become the partner of choice for our clients.

At Qualfon, you’ll find more than just a job, you’ll find a place to grow, develop your career, and be part of a supportive, purpose-driven team.

Responsibilities:

What You’ll Do:

As a Medi-Cal Claims Examiner, you will be responsible for reviewing, processing, and adjudicating suspended healthcare claims to ensure accurate and timely payment. You will apply Medi-Cal policies, regulations, and reimbursement guidelines while evaluating member eligibility, provider information, authorizations, benefits, and supporting documentation. This role is ideal for a detail-oriented professional who enjoys analyzing claims, resolving issues, and working in a fast-paced healthcare environment while maintaining a high standard of accuracy and confidentiality.

Review and adjudicate suspended claims to ensure accurate processing and payment in accordance with established guidelines.
Confirm member eligibility, provider information, required authorizations, and covered benefits.
Evaluate medical records, claim forms, billing details, and supporting documentation to determine appropriate claim outcomes.
Identify discrepancies and resolve claim errors to ensure accurate adjudication.
Investigate and resolve claims-related issues while meeting established quality, productivity, and turnaround-time standards.
Apply Medi-Cal policies, regulations, reimbursement rules, and payment guidelines consistently and accurately.
Analyze claim information and interpret applicable policies and procedures to determine the appropriate resolution.
Safeguard protected health information and maintain compliance with HIPAA and organizational confidentiality requirements.
Partner with internal teams to address complex claims issues and escalate matters requiring additional review or resolution.
Accurately document claim reviews, actions taken, and final adjudication decisions in the appropriate systems

Qualifications:

What You’ll Bring:

At least two (2) years of experience in Medicaid/Medi-Cal claims processing and adjudication.
Working knowledge of healthcare claims, medical terminology, and billing practices.
Familiarity with CPT, HCPCS, and ICD-10 coding principles.
Strong attention to detail and a commitment to maintaining accuracy while meeting productivity and turnaround-time expectations.
Ability to understand, interpret, and apply policies, procedures, regulatory requirements, and payment guidelines.
Strong analytical, organizational, and time-management skills with the ability to prioritize competing tasks.
Ability to perform effectively in a high-volume, fast-paced production environment.
Excellent verbal and written communication skills.
Ability to independently research, analyze, and resolve claims issues using established guidelines and resources.
Proficiency with claims processing systems, Microsoft Office, and other computer-based applications.
Demonstrated ability to protect confidential information and appropriately handle sensitive member and provider data.

EEO Statement

QUALFON is an equal opportunity employer. QUALFON provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity, national origin, age, disability, genetic information (including testing and characteristics), marital status, ancestry, status as a covered veteran, uniformed servicemember status and any other characteristic protected under applicable federal, state or local law.

Pay Range: USD $24.00 - USD $24.00 /Hr.

Apply Now

Refine Your Search

claims processor jobs in california

Healthcare Claim Processor

Part-Time Mail Processor

Junior Claims Processor

Lead Claims Specialist - Claims Processing

Payment / Check Processor

Medical Equipment Processor (MEP) – San Leandro, CA

Title Express Processor (In-Office)

Claims Processor 3

Central Processing Specialist I/II

Claims Processor 1

Sales Order Processor

Service Fulfillment Processor

AM-Warehouse Returns Processor

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