Top 119 Claims representative Jobs in Riverside Ca

Denial and Appeals Management Clerk
Riverside-San Bernardino Co. Indian Health, Inc —Grand Terrace, CA
- $22 - $23 an hour
- Weekends as needed
- Hybrid work
- Background check
- BLS Certification
- HIPAA
- Health insurance
- Dental insurance
Business Office Manager
Menifee Lakes Post Acute —Menifee, CA
- $36 - $42 an hour
- Full-time
- Skilled nursing facility
- Customer service
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
11d
Claims Specialist
PRSH Holdings Inc. —Riverside, CA
- $85,000 - $115,000 a year
- Full-time
- Microsoft Word
- Clean driving record
- 7 years
- Paid holidays
- Health insurance
5d
Sr. Construction Liability Claim Representative
Travelers —Diamond Bar, CA
- $85,600 - $141,200 a year
- Customer service
- High school diploma or GED
- Analysis skills
- Wellness program
- Paid holidays
1d
Provider Dispute Resolution Specialist
LSMA Management Inc —San Bernardino, CA
- $33.50 - $39.50 an hour
- Full-time
- 5 years
- Writing skills
- English
Senior Representative, Health Plan Provider Relations (Must Reside in CA) Must have Contract exp
Molina Healthcare —Riverside, CA
- $73,008 - $111,967 a year
- Full-time
- Medical office experience
- Contracts
- Senior level
- Health insurance
Claims Associate - Workers Compensation (On-Site - Rancho Cucamonga)
Sedgwick —Rancho Cucamonga, CA
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Health savings account
- Disability insurance
Transportation Network Representative
Inland Empire Health Plan —Rancho Cucamonga, CA
- $27.43 - $35.66 an hour
- Extended hours
- Hybrid work
- Microsoft Word
- Mid-level
- Office
- Disability insurance
- Health insurance
Patient Account Representative
San Antonio Regional Hospital —Upland, CA
- $23.00 - $31.82 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Customer service
Claims Specialist
Pavement Recycling Systems, Inc —Jurupa Valley, CA
- $85,000 - $115,000 a year
- Full-time
- Microsoft Word
- Clean driving record
- 7 years
- Paid holidays
- Health insurance
Warranty Clerk
Pedder Auto Group —Moreno Valley, CA
- $25 - $35 an hour
- Dealership
- Research
- Mid-level
Quick Apply
10d
Claim Operations Specialist
The Travelers Companies, Inc. —Diamond Bar, CA
- $45,400 - $74,900 a year
- Hybrid work
- Computer literacy
- Office
- High school diploma or GED
- Wellness program
- Paid holidays
Customer Service Representative - State Farm Agent Team Member
Josh Terraneau - State Farm Agent —Riverside, CA
- $21 - $28 an hour
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- 401(k) matching
Quick Apply
Member Services Representatives - Medicare (Short-Term)
Inland Empire Health Plan —Rancho Cucamonga, CA
- $23 an hour
- Full-time
- HIPAA
- Windows
- High school diploma or GED
- Disability insurance
- Dental insurance
12d
Customer Service Rep - Cabinets Wholesale (monthly bonus opportunities)
West USA International Inc —Pomona, CA
- $18 - $20 an hour
- Full-time
- English
- Residential
- Microsoft Office
- Paid time off
- 401(k) 4% Match
Quick Apply
Customer Service Representative
Prime Wire and Cable Inc. —Diamond Bar, CA
- From $20 an hour
- Full-time
- Mid-level
- Product management
- In-person
- Health insurance
- Dental insurance
Quick Apply
General Liability Senior Technical Specialist
Travelers —Diamond Bar, CA
- $94,400 - $155,800 a year
- Hybrid work
- Residential
- High school diploma or GED
- Analysis skills
- Wellness program
- Continuing education credits
Insurance Account Representative - State Farm Agent Team Member
Scott Fowler - State Farm Agent —Riverside, CA
- $41,600 - $65,000 a year
- Full-time
- Spanish
- Office
- Entry level
- 401(k)
- Paid time off
Quick Apply
Former Athlete Benefits Representative
Leininger Region - Aflac —Rialto, CA
- $74,000 - $89,500 a year
- Full-time
- Hybrid work
- 18 years or older
- Writing skills
- High school diploma or GED
- Work from home
- Opportunities for advancement
Quick Apply
5d
Sales Representative Entry Level
Leininger Region - Aflac —Rialto, CA
- $68,200 - $87,800 a year
- Full-time
- Hybrid work
- 18 years or older
- Writing skills
- High school diploma or GED
- Work from home
- Opportunities for advancement
Quick Apply
5d

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Denial and Appeals Management Clerk

Riverside-San Bernardino Co. Indian Health, Inc -
Grand Terrace, CA

Apply Now

Job Details

Full-time
$22 - $23 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
Employee discount
Life insurance
Retirement plan

Qualifications

Appeals
Medicare
Commercial insurance knowledge
Managed care organization experience
BLS Certification
Regulatory compliance in claims processing
HIPAA
Medical coding guidelines
High school diploma or GED
Cultural competency
Health information regulatory compliance
Medical explanation of benefits reviews
Medical claims submission
Medical Billing Certification
Clinical confidentiality policies
Insurance claims appeal handling
Medical terminology

Full Job Description

Summary:

Applicant must possess a high school diploma or equivalent. An associate degree in healthcare administration or finance is preferred. Certification as a Certified Professional Biller (CPB) is required. A minimum of two years of experience in healthcare revenue cycle, medical billing, claims processing, collections, and denial management is required. Experience with Medicare, Medi-Cal, Managed Care, and Commercial Insurance payers is required. Experience in an FQHC, Tribal Health, or community health center is preferred. NextGen experience is preferred.Must have knowledge of medical terminology, coding concepts, claim adjudication, EOBs, ERAs, payer portals, denial and appeals management, timely filing limits, and appeal processes. Experience with EHR/practice management systems, NextGen, and clearinghouses such as Waystar is preferred. Must understand healthcare regulations, coding standards, and payer requirements related to claim denials and appeals. Must be able to maintain confidentiality and ensure HIPAA compliance while prioritizing workload and consistently meeting productivity goals. Applicant must have a CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained prior to orientation or within 90 days of employment. The Denials and Appeals Management Clerk is responsible for reviewing, researching, resolving, and appealing denied or underpaid claims to maximize reimbursement and reduce accounts receivable delays. This position works closely with third-party payers, billing, coding, credentialing, providers, and internal departments to ensure timely payment, accurate claim submission, and compliance with applicable regulations. The role also analyzes denial trends, identifies payer issues, supports process improvement, and helps prevent future denials.This position is eligible for a hybrid work schedule. Must be able to work with the Indian Community and be sensitive to the Indian culture and its needs.

Major Duties and Responsibilities:

Review and prioritize high dollar and timely filing-sensitive denied claims from mail, clearinghouses, payer portals, and work queues.
Analyze denied claims, reason codes, and determine appropriate corrective actions.
Identify root causes related to coding, insurance eligibility, referral, authorization, provider documentation, or billing errors.
Correct claims and resubmit within payer filing limits
Monitor aged, denied claims, and maintain denial work queues.
Document all actions and follow-up activities in the practice management system.
Stay current on changes to payer policies, billing regulations, and reimbursement guidelines.
Adhere to patient privacy and confidentiality requirements, including HIPAA regulations.
Prepare and submit first-level and second-level appeals as appropriate.
Gather supporting medical records, referrals, authorizations, and documentation.
Draft appeal letters citing payer policies, medical necessity, coding guidelines, and regulatory requirements.
Track appeal status through payer portals, telephone calls, and payer response deadlines until resolution.
Escalate unresolved claims to management when appropriate or payer representatives.
Coordinate peer-to-peer reviews and reconsideration requests when necessary.
Identify denial trends by payer and denial reason and recurring issues.
Assist in denial prevention education and implement corrective action plans.
Collaborate with coding, billing, patient registration, medical records, and providers to prevent future denials.
Maintain denial logs and appeal tracking spreadsheets.
Support quality assurance and internal audits.
Participate in revenue cycle meetings and payer issue resolution.
Monitor denial rates and appeal outcomes.
Assist in preparing monthly reports that include denial volume, top denial categories, appeal success rates, timely filing issues, and underpayment trends.
This position requires working weekends and evenings, if needed.
Other duties assigned relevant to the position, with relevant training and competency assessment documented.

Qualifications

Education:

High School Diploma or Equivalent required. Associate degree in healthcare administration, or finance preferred.

Certification as a Certified Professional Biller (CPB) is required.

Experience:

A minimum of two years’ experience in healthcare revenue cycle, medical billing, claims processing, collections, and denial management is required. Experience with Medicare, Medi-Cal, Managed Care, and Commercial Insurance payers is required.
Experience in an FQHC, Tribal Health, or community health center is preferred.

Certification:

CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained prior to orientation. Certification may obtained within 90 days of employment.

Knowledge of:

Knowledge of medical terminology, CPT, HCPCS, ICD-10-CM Coding concepts, and claim adjudication. Explanation of benefits (EOBs), Electronic Remittance Advice (ERAs), and payer portals. Denial and Appeals Management Clerk. Familiarity with timely filing limits and appeal processes. Proficiency with Electronic Health Records and Practice Management systems (NextGen Preferred). Experience using clearinghouses such as Waystar is preferred. Knowledge of healthcare regulations, coding standards, and payer requirements relevant to claim denials and appeals.

Skill:

Strong analytical, organizational, and problem-solving skills Excellent verbal and written communication skills Microsoft Office applications. Must understand or be willing to receive Native American cultural competency training and employ cultural awareness with our Native American community.

Ability to:

Demonstrated ability to interpret claim denials, review documentation, and develop effective appeal strategies. Proven ability to investigate denials, identify root causes, and implement corrective actions. Ability to prioritize workload and consistently meet productivity goals. Ability to maintain confidentiality and ensure HIPAA compliance. Must be able to work with the Indian Community and be sensitive to the Indian culture and its needs.

Physical Demands:

This position requires prolonged sitting and computer use, occasional lifting of 20 to 25 pounds, and proficiency with computers, keyboards, and standard office equipment. Dexterity of hands with coordination of eye and hand movement.

Remote Work Eligibility:
This position may be eligible for a hybrid work schedule, eligibility is subject to supervisor approval, position requirements, and organizational needs.

Appointment Type:

Full-Time, Non-Exempt

Compensation:

$22.00–$23.00 per hour ($45,760–$47,840 annually, depending on experience and internal equity)

Clinic Location:

San Manuel Indian Health Clinic (11980 Mt. Vernon Ave. Grand Terrance Ca, 92313)

Pay: $22.00 - $23.00 per hour

Benefits:

401(k)
Dental insurance
Employee assistance program
Employee discount
Health insurance
Life insurance
Paid time off
Retirement plan
Vision insurance

Work Location: In person

Apply Now

Refine Your Search

claims representative jobs in riverside ca

Denial and Appeals Management Clerk

Business Office Manager

Claims Specialist

Sr. Construction Liability Claim Representative

Provider Dispute Resolution Specialist

Senior Representative, Health Plan Provider Relations (Must Reside in CA) Must have Contract exp

Claims Associate - Workers Compensation (On-Site - Rancho Cucamonga)

Transportation Network Representative

Patient Account Representative

Claims Specialist

Warranty Clerk

Claim Operations Specialist

Customer Service Representative - State Farm Agent Team Member

Member Services Representatives - Medicare (Short-Term)

Customer Service Rep - Cabinets Wholesale (monthly bonus opportunities)

Customer Service Representative

General Liability Senior Technical Specialist

Insurance Account Representative - State Farm Agent Team Member

Former Athlete Benefits Representative

Sales Representative Entry Level

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