Top 18 Examiner Jobs in Redlands, Ca

Claims Examiner
LSMA Management Inc —San Bernardino, CA
- $28.85 - $33.65 an hour
- Extended hours
- Hybrid work
- Google Workspace
- Customer service
- Writing skills
Claims Examiner 2-Managed Care
Loma Linda University Health —Redlands, CA
- $26.54 - $31.55 an hour
- Full-time
- Computer science
- Microsoft Excel
- Microsoft Outlook
14d
Workers' Compensation Claims Examiner
JT2 Integrated Resources —California
- From $90,000 a year
- Full-time
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Workers Compensation Claims Examiner | Bonus Eligible | Roseville or Long Beach, CA
Sedgwick —California
- Full-time
- Hybrid work
- Background check
- Customer service
- 5 years
- Health savings account
- Disability insurance
Quick Apply
Temporary Polygraph Examiner - As Needed
County of Riverside —Riverside, CA
- $50 an hour
- Temporary
- Background check
- Mid-level
- Driver's License
- Paid holidays
- Disability insurance
Plans Examiner
City of Santee, CA —Magnolia Avenue, CA
- $101,557.42 - $123,444.17 a year
- Online Application
- Background check
- Research
- Mid-level
Xcelys Medical Claims Examiner-REMOTE
NTT DATA —Ontario, CA
- $20 an hour
- Contract
- Remote
- High school diploma or GED
- Analysis skills
- Continuous improvement
Quick Apply
Searcher/Examiner/Customer Service Title
Title Company —Rancho Cucamonga, CA
- $50,000 - $70,000 a year
- Full-time
- Hybrid work
- Mid-level
- Analysis skills
- Communication skills
- Health insurance
- 401(k)
Quick Apply
Xcelys Medical Claims Examiner (Remote)
NTT DATA —Ontario, CA
- $20 an hour
- Contract
- Remote
- Mid-level
- High school diploma or GED
- Analysis skills
- Health savings account
- AD&D insurance
Quick Apply
12h
Workers Compensation - Claims Examiner | HYBRID | Riverside, CA
Sedgwick —Riverside, CA
- Full-time
- Hybrid work
- Background check
- Customer service
- 5 years
- Health savings account
- Disability insurance
Quick Apply

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Title Company —Rancho Cucamonga, CA
Prefer 3 years of experience in title examination or customer service in title insurance. Respond promptly and professionally to customer inquiries.
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State of Ohio - Public Safety —Hilliard, OH
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examiner jobs near redlands, ca

Claims Examiner

LSMA Management Inc
San Bernardino, CA

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Job Details

Full-time
$28.85 - $33.65 an hour

Qualifications

Contract documentation review
Google Workspace
Customer communication
Pricing
Contract review
Customer service
Insurance dispute resolution
Writing skills
Regulatory compliance in claims processing
Contract interpretation
HIPAA
Medical coding guidelines
Medical claims processing software
Medical billing discrepancy resolution
Health insurance knowledge
Health information regulatory compliance
Productivity software
Medical claim denial management
DRG

Full Job Description

Description:

JOB SUMMARY

The Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical claims for a management services organization (MSO) supporting medical clinics and Independent Practice Association (IPA) groups. This role applies plan and contract rules, reimbursement methodologies, and medical billing/coding guidelines to ensure claims are processed accurately, timely, and in compliance with federal and California requirements. The Claims Examiner collaborates with Provider Relations/Network, Contracting, Utilization Management, Finance, Member/Patient Services, and Compliance to resolve pended claims, denials, adjustments, and provider disputes while meeting production and quality standards.

Requirements:

MINIMUM & PREFERRED QUALIFICATIONS

Education

Minimum: High school diploma or equivalent, or equivalent combination of education and experience.

Experience

Minimum: Two years of healthcare claims processing or claims adjudication experience, including experience interpreting benefits and reimbursement rules. Experience working with claim denials, adjustments, and provider inquiries. Working knowledge of medical billing/coding basics (CPT, HCPCS, ICD-10, revenue codes) and how coding impacts adjudication. Experience using claims systems and/or EDI workflows preferred.

Skills, Knowledge & Abilities

Knowledge of end-to-end claims lifecycle including intake, edits, adjudication, pricing, payment, denials, adjustments, and recoveries.
Ability to interpret provider contracts, fee schedules, and reimbursement methodologies (FFS, DRG/APC, capitation, bundled payments).
Strong analytical and problem-solving skills; able to research discrepancies and determine appropriate resolution.
Attention to detail and accuracy with ability to meet production, turnaround time, and quality standards.
Effective written and verbal communication; professional customer service with providers and internal stakeholders.
Working knowledge of HIPAA transactions (837/835) and claims-related regulatory requirements including prompt pay and dispute resolution.

Proficient with claims systems, Microsoft Office/Google Workspace, and basic reporting tools.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or hybrid office environment and involves prolonged periods of sitting, computer use, and data review. The role requires sustained concentration, analytical thinking, and attention to detail to ensure claims accuracy and regulatory compliance. Occasional lifting of materials up to approximately 10–20 pounds may be required. The position may require extended work hours or weekend work to meet operational and regulatory deadlines.

PAY RANGE

$28.85 - $33.65 / hourly

Apply Now

Refine Your Search

examiner jobs in redlands, ca

Claims Examiner

Claims Examiner 2-Managed Care

Workers' Compensation Claims Examiner

Workers Compensation Claims Examiner | Bonus Eligible | Roseville or Long Beach, CA

Temporary Polygraph Examiner - As Needed

Plans Examiner

Xcelys Medical Claims Examiner-REMOTE

Searcher/Examiner/Customer Service Title

Xcelys Medical Claims Examiner (Remote)

Workers Compensation - Claims Examiner | HYBRID | Riverside, CA

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