Top 24 claims representative Jobs in fresno ca

Claims Analyst
INNOVATIVE INTEGRATED HEALTH —Fresno, CA
- $21 - $29 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Mid-level
- Ability to lift 50 pounds
- Health savings account
- Health insurance
Property & Casualty Claims Advocate
HUB International —Fresno, CA
- $68,000 - $100,000 a year
- Online Application
- Microsoft Outlook
- Writing skills
- Mid-level
- Health savings account
- Disability insurance
Customer Service Representative - State Farm Agent Team Member
Johnny Williamson - State Farm Agent —Fresno, CA
- $50,000 - $70,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- 401(k) matching
Quick Apply
Billing Specialist
WESTCARE CALIFORNIA INC —Fresno, CA
- $24 an hour
- Full-time
- CPR Certification
- Current TB test
- Mid-level
Quick Apply
5d
Billing Specialist
Valley Health Team, Inc. —Fresno, CA
- $21.25 - $29.41 an hour
- Temporary
- Background check
- Spanish
- OSHA
- Health insurance
- Dental insurance
Quick Apply
Warranty Admin
RV Country Inc —Fresno, CA
- $45,000 - $65,000 a year
- Dealership
- Administrative experience
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply
2d
Account Manager, Personal Lines
HUB International —Fresno, CA
- $70,000 - $75,000 a year
- Online Application
- Microsoft Outlook
- Writing skills
- Mid-level
- Health savings account
- Disability insurance
Account Manager II, Commercial Lines
HUB International —Fresno, CA
- $65,000 - $85,000 a year
- Online Application
- Microsoft Outlook
- Computer literacy
- Writing skills
- Health savings account
- Disability insurance
C&C Manager
Accelerated Urgent Care —Clovis, CA
- $32 - $39 an hour
- Full-time
- High school diploma or GED
- Bachelor's degree
- Recruiting
Patient Services Representative - II
LucyRx —Fresno, CA
- $17.50 - $20.00 an hour
- Weekends as needed
- Microsoft Outlook
- Mid-level
- High school diploma or GED
Quick Apply
12d
Bi-lingual Pharmacy Tech Rep, 11a-8p ET (Home-based)
IQVIA —Fresno, CA
- $18 an hour
- Full-time
- Remote
- Spanish
- HIPAA
- English
Account Manager, Commercial Lines
HUB International —Fresno, CA
- Online Application
- Microsoft Outlook
- Writing skills
- Mid-level
- Health savings account
- Disability insurance
Bodily Injury Adjuster II
First Acceptance Services Inc —United States
- Remote
- Microsoft Excel
- Mid-level
- High school diploma or GED

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Property and Casualty Adjuster
CUSTARD INSURANCE ADJUSTERS —Fresno, CA
College bachelor’s degree or equivalent preferred; prior property and casualty claims adjusting experience required; valid driver’s license and reliable…
$24 - $30 an hour
Quick Apply
Senior Claims Adjuster Workers Compensation
Gallagher Bassett —Fresno, CA
Appropriately licensed and/or certified in all states in which claims are being handled. You’re part of a team that shows up, stands together, and leads with…
$71,500 - $102,000 a year
2d

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Sedgwick —Dublin, OH
PRIMARY PURPOSE : To provide excellent service displaying empathy to callers regarding claims for multiple lines of business, including but not limited to,…
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Patient Service Representative
quantum-health —Dublin, OH
Resolve inquiries efficiently by handling inbound/outbound calls and addressing concerns in a timely manner. Tech Savvy: Strong administrative/technical skills;…
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Claims Analyst

INNOVATIVE INTEGRATED HEALTH -
Fresno, CA

Apply Now

Job Details

Full-time
$21 - $29 an hour

Benefits

Health savings account
Health insurance
Dental insurance
401(k)
Flexible spending account
Paid time off
Employee assistance program
Vision insurance
Employee discount
Life insurance
Referral program
Paid sick time

Qualifications

Data integrity assurance
Contract documentation review
Financial close processing
Contract management
Contract review
Microsoft Excel
Financial data reconciliation
Medicare
Managed care
Data validation techniques
Medicare coding guidelines
Managed care organization experience
Health insurance policy knowledge
CMS
Regulatory compliance in claims processing
Physiology knowledge
Mid-level
Data summary reports
Data integrity and documentation
CMS regulatory compliance
Driver's License
Medical billing data reporting
Medicare regulations
Task prioritization
Health information data integrity
Decision making
Desktop applications
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Medical claims submission

Full Job Description

MUST LIVE IN ANAHEIM, BAKERSFIELD, OR FRESNO, CA AREA

Who We Are

To empower our senior participants to age at home with dignity through personalized, comprehensive care plans that deliver high-quality health and human services along with strong community support.

Benefits

401(k)
Dental insurance
Employee assistance program
Employee discount
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid sick time
Paid time off
Referral program
Retirement plan
Vision insurance

Job Summary

The Claims Analyst is responsible for accurate and timely processing, auditing, and reconciliation of medical and ancillary claims for services provided to PACE participants. The analyst ensures compliance with federal and state regulations, including 42 CFR Part 460 (PACE Regulations), as well as organizational contracts and policies. This position supports PACE’s mission by ensuring that provider payments are accurate, participants’ services are properly accounted for, and financial data is reliable for reporting and capitation management.

Essential Job Functions
Duties include, but are not limited to:

Serve as the first point of contact for claims intake, reviewing submitted claims to ensure accuracy and completeness.
Address and resolve intake issues, including missing information, coding errors, or eligibility concerns, and coordinate with providers and internal departments to facilitate timely claims processing.
Assist with all other activities in the claims process, including provider setup to ensure accurate rates and terms in the claims system, supporting provider education, coordinating with the electronic clearinghouse to confirm claim receipt, processing claim adjudication, communicating denied claims, and helping to resolve provider disputes (PDRs).
Analyze and audit claims to ensure compliance and provide solutions to resolve claims errors.
Support encounter data validation and submission to regulatory agencies.
Support monthly financial close activities by reconciling paid claims with general ledger data.
Provides feedback and justification of denied claims to providers, as needed.
Aids providers on how to submit claims and verification of participant’s eligibility.
Conducts contract review and sets rates within the claim adjudication system.
Collaborates with other departments in the organization.
Conducts follow-up activity for claims held until the claim and/or PDR is closed.
Ensure claims are supported by appropriate authorizations and documentation per PACE regulatory guidelines.
Support encounter data validation and submission to regulatory agencies.
Conducts coordination of benefits, insuring that claims impact primary and secondary insurance, as appropriate.
Review and analyze claims loss, expense reserves and reconcile claims reports with authorizations.
Assist in preparation for audits and compliance reviews by Centers for Medicare & Medicaid Services (CMS), California Department of Health Care Services (DHCS), or internal auditors.
Prepare periodic claims reports for management, identifying payment errors, turnaround time, and cost trends.
Assists Claims Manager to identify exposures to the company and reports to senior-level management on pending claims and litigation that may have an adverse impact on corporate goals.
Verify pricing of claims through contracted rates and Medicare/Medicaid fee schedules.
Demonstrate workplace behavior that promotes organizational core values of honesty and integrity, respect for others, encouragement, high quality care and patient-centeredness.
Attend and participate in staff meetings, in-services, projects, and committees as assigned (Some travel may be required based on organizational needs).
Adhere to and support the organization’s practices, procedures, and policies including assigned break times and attendance.
Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
Ability to work independently and meet deadlines in a fast-paced environment.
May be required to use personal vehicle, if applicable. If using a personal vehicle, a valid California Driver’s License is required.

Knowledge, Skills and Abilities

Proficient in computer applications with demonstrated ability to use Microsoft Word, Excel, and related systems effectively.
Strong organizational and time-management skills with the ability to prioritize multiple tasks, manage shifting priorities, and meet deadlines in a fast-paced environment.
Exceptional attention to detail and accuracy when reviewing, processing, and analyzing information.
Excellent written and verbal communication skills, including strong grammar, reading comprehension, and the ability to present information clearly in both one-on-one and group settings.
Ability to communicate professionally and confidently with internal and external stakeholders.
Demonstrated critical thinking, self-initiative, and sound judgment in problem-solving and decision-making.
Ability to quickly learn and apply department policies, procedures, goals, and services.
Self-motivated and disciplined, with the ability to work independently and manage responsibilities effectively, including in a remote or hybrid environment.

Working Conditions and Physical Demands

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Ability to access all areas of the center throughout the workday.
Ability to lift a minimum of 35 occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance from another qualified employee when attempting to lift or transfer objects over 50 pounds.
Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.
Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment.
Primarily sedentary work with prolonged computer use.
Primarily remote work; must be able to work effectively in a virtual team setting.

Experience

2+ years of professional experience processing and analyzing claims for PACE, Medicare Advantage, or Medicaid Managed Care is strongly preferred.
Experience with institutional (UB-04), professional (CMS-1500), and dental (ADA) claims.
Experience with ICD-10, CPT, and HCPCS coding.
Understanding of physiology, medical terminology, and disease processes (strongly preferred).
Experience with the QuickCap claims system (preferred).
Understanding of PACE reimbursement policies, encounter data, and provider contracting (preferred).

Education

A minimum of an associate’s degree required (experience in lieu of degree may be considered).
Bachelor’s degree is preferred.
Certificate in Medical Billing, preferred

Core Values

CARE is central to what we do, prioritizing the well-being, dignity, and independence of our senior participants.
COMPASSION in every interaction, ensuring kindness, empathy, and understanding guide our care.
CULTURE that reflects the diverse backgrounds of those we serve and fosters a workplace where every team member feels supported, valued, and empowered to grow.
COMMUNITY that fosters connection, belonging, and support for participants and their families.
COMMITMENT to quality improvement, innovation, and delivering healthier outcomes.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Apply Now

Refine Your Search

claims representative jobs in fresno ca

Claims Analyst

Property & Casualty Claims Advocate

Customer Service Representative - State Farm Agent Team Member

Billing Specialist

Billing Specialist

Warranty Admin

Account Manager, Personal Lines

Account Manager II, Commercial Lines

C&C Manager

Patient Services Representative - II

Bi-lingual Pharmacy Tech Rep, 11a-8p ET (Home-based)

Account Manager, Commercial Lines

Bodily Injury Adjuster II

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