Top 402 Claims processing Jobs in Lomita Ca

Claims Analyst
Clever Care Health Plan —Huntington Beach, CA
- $88,000 - $100,000 a year
- Full-time
- Hybrid work
- Background check
- Writing skills
- Mid-level
Claims Representative (IAP) - Workers Compensation Training Program | Long Beach, CA
Sedgwick —Long Beach, CA
- Office
- High school diploma or GED
- Bachelor's degree
- Health savings account
- Disability insurance
Claims Auditor, Managed Care (remote)
Cedars-Sinai —Los Angeles, CA
- $27.18 - $42.13 an hour
- 8 hour shift
- Remote
- Mid-level
- High school diploma or GED
- Bachelor's degree
- Health insurance
- Dental insurance
Pharmacy Technician
Nest-Rx —Costa Mesa, CA
- $20 - $25 an hour
- 8 hour shift
- Computer literacy
- High school diploma or GED
- US work authorization
- Free parking
- Paid training
Quick Apply
Pharmacist
KabaFusion —Los Angeles, CA
- $62 - $72 an hour
- Full-time
- Microsoft Outlook
- Computer literacy
- Bachelor of Science
- Paid holidays
- Disability insurance
Quick Apply
Customer Service Process & VOC Analyst / Customer Experience Process Optimization Specialist/Supervi
Speed Express —Montebello, CA
- $60,000 - $90,000 a year
- Full-time
- Writing skills
- English
- Mid-level
- Health insurance
- 401(k)
Quick Apply
4d
Human Resources and Documentation Analyst
Vista Paint Corporation —Fullerton, CA
- $20 - $23 an hour
- Full-time
- Mid-level
- Office
- Administrative experience
- Health savings account
- Health insurance
Quick Apply
8d
Supervisor, Medicare Claims
Clever Care Health Plan —Huntington Beach, CA
- $80,000 - $90,000 a year
- Full-time
- Hybrid work
- Background check
- Writing skills
- Mid-level
Manager, Medicare Enrollment and Reconciliation
Clever Care Health Plan —Huntington Beach, CA
- $90,000 - $110,000 a year
- Full-time
- Background check
- Management
- Writing skills
Onsite Human Resources Manager
Alco designs —Gardena, CA
- $80,000 - $110,000 a year
- Full-time
- Spanish
- 5 years
- English
- Health insurance
- Dental insurance
Quick Apply
[KOTRA] Daesang America, Multi-Position
KOTRA Los Angeles —City of Industry, CA
- $48,000 - $90,000 a year
- Full-time
- Marketing
- Merchandising
- Mid-level
Quick Apply
Customer Service Representative (Bilingual Mandarin or Cantonese/English)
KCAL Insurance Agency —Hacienda Heights, CA
- From $20 an hour
- 8 hour shift
- Microsoft Outlook
- Customer service
- English
- Profit sharing
- Paid holidays
Quick Apply
Payment Assistant Support
Confidential —Los Angeles, CA
- $18 - $20 an hour
- Temporary
- Research
- Mid-level
- Office
Quick Apply
Human Resources Manager
PASONA N A, INC. —Cerritos, CA
- $80,000 - $90,000 a year
- Full-time
- Hybrid work
- Spanish
- 5 years
- Office
- Dental insurance
- 401(k)
2d
Account Receivable Specialist(English-Korean Bilingual)
Innovative beauty and wellness brands —La Mirada, CA
- $60,000 - $80,000 an hour
- Full-time
- English
- Mid-level
- Microsoft Office
- Paid time off
- Employee discount
Quick Apply
4d
Food Technologist
Futures Consulting, LLC —Huntington Park, CA
- $80,000 - $85,000 a year
- Full-time
- Bachelor of Science
- Mid-level
- 3 years
- Paid holidays
- Health insurance
Quick Apply
9d
Claims Specialist
Liberty Mutual —Los Angeles, CA
- $57,000 - $101,000 a year
- Full-time
- Customer service
- Mid-level
- Bachelor's degree
4d
Revenue Cycle Analyst (Remote)
Cedars-Sinai —Los Angeles, CA
- $77,022.40 - $119,392.00 a year
- 8 hour shift
- Remote
- Mid-level
- Finance
- High school diploma or GED
- Paid time off
- 403(b)
Claims Investigator/Examiner
AIDS Healthcare Foundation —Los Angeles, CA
- $34 - $36 an hour
- Mid-level
- Organizational skills
- Health insurance
Quick Apply
Medical Claims Intake Coordinator
UCLA Health —Los Angeles, CA
- $26.42 - $37.49 an hour
- Medical office experience
- No high school diploma
- Mid-level

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Claims Analyst

Clever Care Health Plan -
Huntington Beach, CA

Apply Now

Job Details

Full-time
$88,000 - $100,000 a year

Qualifications

Managed care
Managed care organization experience
High school diploma or GED
Health insurance knowledge
Task prioritization

Full Job Description

Applicants must be located in Southern California in Los Angeles or Orange County,

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We? ✨

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us?

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

The 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. Claim analyst is responsible for the end to end process for any configuration and automation projects

Functions & Job Responsibilities

Includes claims systems utilization, capacity analyses/planning and reporting including claims-related business and systems analysis
Excellent analytical, problem solving and troubleshooting activities.
Must be able to analyze requirements for any Claim related projects
Provide configuration support based on business needs including but not limited to DOFR, Benefits, and MOOP.
Evaluate and Analyze any business needs including but not limited to DOFR, Benefits, and MOOP related to Claims Department.
Review and recommend improvement to current configuration
Document and Report to Senior Claims analyst and Director of Medicare Operations
Perform Test Cases
Run Test, study and analyze result, and troubleshoot if necessary
Ability to pull and analyze reports necessary to support claim department needs
Validating accuracy of reports produced and submitted by the Claims Department.
Assists in preparing and reviewing cases for regulatory and other health plan reports and requirements.
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Assists in validating claim compliance reports
Create Business Requirement Document as needed
Create CMS Reports as needed by Director of Operations
Manage and support new projects and regulatory updates in accordance with CMS

Qualifications

Education/Experience:

High School diploma or equivalent required. Associate degree or an equivalent combination of education and claims processing experience preferred. Bachelor’s degree in related field (preferred).
2 to 5 years of experience in a managed care claims processing environment required
Demonstrate knowledge of applicable claims processes (e.g., end-to-end claims cycle, auto-adjudication, manual work processes, payment methodologies, rework/adjustment processes)
Terminology, CPT, revenue codes, ICD10, HCPCS codes as it relates to claims processing adjudication. Core claims processing systems and healthcare authorization systems.

Skills:

Perform in a fast-paced environment and work under pressure.
Communicate clearly and concisely, both verbally and in writing to individuals of diverse backgrounds.
Organize, plan and prioritize work activities, possess analytical and problem-solving skills.
Troubleshoot claims adjudication problem areas.
Encourage and utilize suggestions and new ideas.
Comprehend and interpret provider contracts and Divisional Financial of Responsibility (DOFR).
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.

Wage Range: $88,000.00 to $100,000.00 per year

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

Must be able to travel when needed or required
Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.

Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

#LI-Hybrid

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Refine Your Search

claims processing jobs in lomita ca

Claims Analyst

Claims Representative (IAP) - Workers Compensation Training Program | Long Beach, CA

Claims Auditor, Managed Care (remote)

Pharmacy Technician

Pharmacist

Customer Service Process & VOC Analyst / Customer Experience Process Optimization Specialist/Supervi

Human Resources and Documentation Analyst

Supervisor, Medicare Claims

Manager, Medicare Enrollment and Reconciliation

Onsite Human Resources Manager

[KOTRA] Daesang America, Multi-Position

Customer Service Representative (Bilingual Mandarin or Cantonese/English)

Payment Assistant Support

Human Resources Manager

Account Receivable Specialist(English-Korean Bilingual)

Food Technologist

Claims Specialist

Revenue Cycle Analyst (Remote)

Claims Investigator/Examiner

Medical Claims Intake Coordinator

I want to receive the latest job alert for claims processing in lomita ca

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