Top 72 Claims representative Jobs in San Bernardino Ca

Supervisor, Transportation Network Management
Inland Empire Health Plan —Rancho Cucamonga, CA
- $80,059.20 - $106,059.20 a year
- Full-time
- Hybrid work
- Microsoft Word
- Mid-level
- Office
- Disability insurance
- Health insurance
Business Office Assistant
Community Care and Rehab —Riverside, CA
- From $20 an hour
- Full-time
- Microsoft Excel
- Skilled nursing facility
- Customer service
- Health insurance
- Dental insurance
Quick Apply
6d
DQA Representative
PRIORITY AMBULANCE CALIFORNIA LLC —Redlands, CA
- $25 - $35 an hour
- Nursing
- Customer service
- HIPAA
DQA Representative
PRIORITY AMBULANCE CALIFORNIA LLC —Rancho Cucamonga, CA
- $25 - $35 an hour
- Nursing
- Customer service
- HIPAA
Claims: Customer Service Representative
Choice Medical Group —Apple Valley, CA
- $17 - $24 an hour
- Full-time
- Background check
- Customer service
- Computer literacy
- 401(k) 4% Match
- Employee assistance program
Quick Apply
11d
Workers' Compensation Claims Adjuster - III
Professional Search —California
- Up to $60 an hour
- Temporary
- Remote
- 5 years
- Conflict management
- Senior level
- Health savings account
- Health insurance
Quick Apply
Patient Account Representative
San Antonio Regional Hospital —Upland, CA
- $21.00 - $29.12 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Customer service
Claims Representative - Workers Compensation (On-Site - Rancho Cucamonga)
Sedgwick —Rancho Cucamonga, CA
- Full-time
- Customer service
- Mid-level
- Office
- Health savings account
- Disability insurance
2d
Electronic Services Representative
La Loma Federal Credit Union —Loma Linda, CA
- $22 - $25 an hour
- Full-time
- Inventory control
- Mid-level
- Quality control
- Health insurance
- Dental insurance
Quick Apply
5d
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
Claims Associate - Workers Compensation | Ontario, CA
Sedgwick —Ontario, CA
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Health savings account
- Disability insurance
Provider Service Representative
Optum —Ontario, CA
- $18 - $32 an hour
- Full-time
- Spanish
- Pass drug screening
- English
- AD&D insurance
- Employee stock purchase plan
Certified Medical Biller and Coder
Cajon Medical Group, PC —Redlands, CA
- $25 an hour
- Full-time
- Bilingual
- Customer service
- Medical office experience
- Health insurance
- Dental insurance
Quick Apply
7d
Field Site Inspector
Allied Universal® Compliance and Investigations —San Bernardino, CA
- $25 - $30 an hour
- Weekends as needed
- Public speaking
- High school diploma or GED
- Driver's License
- AD&D insurance
- Paid holidays
Quick Apply
5d
Property Claims Specialist Field I
Mercury Insurance Services, LLC —Rancho Cucamonga, CA
- $61,864 - $108,197 a year
- Overtime
- Remote
- Bilingual
- Military
- Writing skills
- Paid holidays
- Health insurance
Revenue Recovery Analyst
LSMA Management Inc —San Bernardino, CA
- $35 - $40 an hour
- Full-time
- Microsoft Excel
- Office
- Finance
Collector
Arrowhead Orthopaedics —Colton, CA
- $18 - $24 an hour
- Full-time
- Microsoft Outlook
- Computer literacy
- Research
Provider Dispute Resolution Specialist
LSMA Management Inc —San Bernardino, CA
- $33.50 - $39.50 an hour
- Full-time
- 5 years
- Writing skills
- English
Customer Service Representative - State Farm Agent Team Member
Scott Manning - State Farm Agent —Colton, CA
- $20 - $30 an hour
- Full-time
- Spanish
- Office
- Communication skills
- Health insurance
- Paid time off
Quick Apply
Property Claims Specialist Field II
Mercury Insurance Services, LLC —Rancho Cucamonga, CA
- $76,829 - $142,213 a year
- Overtime
- Bilingual
- Military
- Writing skills
- Paid holidays
- Health insurance

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Supervisor, Transportation Network Management

Inland Empire Health Plan -
Rancho Cucamonga, CA

Apply Now

Job Details

Full-time
$80,059.20 - $106,059.20 a year

Benefits

457(b)
Disability insurance
Health insurance
On-site gym
Dental insurance
Flexible spending account
Vision insurance
Opportunities for advancement
Life insurance

Qualifications

Road transportation operations
Team leadership
Standard Operating Procedures (SOPs) implementation
Operational management
Coaching
Performance management strategy
Company vehicle operation
Driver's License
Policy & process development
Vendor relationship management
Logistics vendor relationship management
Healthcare policy implementation
Standard operating procedures (SOPs)
Policy Development
Stakeholder relationship building
Standard operating procedures drafting

Full Job Description

Overview:

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

The Supervisor, Transportation Network Management is responsible for managing day-to-day transportation unit operations to ensure compliance, service quality, and member satisfaction. This role oversees provider performance through audits, inspections, scorecards, and action improvement plans (PIPs/CAPs), while ensuring Voice of Member initiatives and outreach programs are executed effectively. The Supervisor monitors billing investigations, credentialing enforcement, and quality assurance processes, running transportation provider, trip, and Quality Assurance reports to identify trends and issues. Additionally, the position facilitates Fraud, Waste, and Abuse signals by routing cases to Special Investigations Unit/Compliance through the Manager. The Supervisor also provides guidance and support to Team Members, ensuring adherence to standards, proper documentation, and effective issue resolution. This role requires strong organizational skills, attention to detail, and the ability to lead operational activities that support IEHP’s transportation strategy and member experience goals.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Key Responsibilities:

Manage Assigned-Representative Contact Operations: Publish assigned provider and facility contacts for Representatives, ensure availability and backup coverage, and monitor adherence to response and resolution Service Level Agreements. Maintain accurate documentation and trigger escalations per protocol to ensure timely issue resolution and service continuity.
Monitor Provider Performance and Implement Action Improvement Plans: Review monthly scorecards, initiate and track Performance Improvement Plans (PIPs) and Action Improvement Plans, and address recurring compliance issues. Remediate grievance trends with contracted transportation providers and facilities to maintain quality and regulatory standards.
Lead Investigations and Ensure Billing Integrity: Conduct investigations into provider and rideshare discrepancies, compile decision-ready cases, and implement measures to reduce Accounts Payable rework and improve first-pass payment accuracy.
Coordinate Facility Liaison Activities and STO Governance: Oversee Representatives at high-volume facilities, train staff on booking, authorization, and STO changes, and promote portal adoption and rule adherence to improve operational efficiency.
Optimize Dispatch and Provide Tiering Inputs: Maintain day-to-day trip assignment hygiene by considering capacity, proximity, and vehicle type. Input tiering signals to improve on-time pickup/drop-off (OTP/OTD) and overall reliability.
Execute Voice of Member (VoM) Initiatives and Feedback Loop: Validate IVR/text triggers and configurations, monitor response rates, and translate insights into actionable improvements such as provider coaching, assignment adjustments, and policy clarifications. Funnel call center script and process issues to the Manager and QA Specialists for resolution
Facilitate Audits and Hybrid Inspections: Coordinate and track risk-based field audits (baseline 20% of providers per quarter) and virtual/in-person inspections. Validate documentation completeness and audit readiness to ensure compliance.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Qualifications:

Education & Requirements

Four plus (4+) years of experience in a combination of provider relations and transportation operations required
Two plus (2+) years of experience in people and/or process leadership, including coaching and performance management
Background in compliance policies, SOP development, and vendor/provider relationship management.
Preferred: Preferred experience in the following areas:
- Experience with managed care claims, encounters, and billing investigations
- Experience with Voice of Member (VoM) and Customer Experience (CX) programs, including IVR/text configuration, analytics, and closed-loop improvement processes
Associate’s degree in Business Administration, Public Administration, Healthcare Administration, or a related field from an accredited institution required
- In lieu of the required Associate’s degree, a minimum of two (2) years of additional relevant work experience is required for this position
- This experience is in addition to the minimum years listed in the Experience Requirements above
Bachelor’s degree in Business Administration, Public Administration, Healthcare Administration, or a related field from an accredited institution preferred
Lean Six Sigma and/or CHC certification preferred
Must have a valid California Driver’s license and valid automobile insurance
Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Key Qualifications

Knowledge and understanding in the following areas:
- NEMTAC standards and competency guidelines.
- Healthcare compliance standards, including CMS, DHCS, DMHC, and Medi-Cal transportation benefit regulations.
- Provider performance management frameworks, including scorecards and action improvement plans.
- Dispatch optimization principles and trip assignment best practices.
- Standard operating procedures for Standing Orders (STO), PCS forms, and credentialing enforcement.
- Basic principles of billing integrity and fraud detection protocols.
- Strong understanding of transportation workflows and the impact of missed or delayed trips on member experience.
- Familiarity with IEHP transportation policy, Medi-Cal regulations, and NEMT authorization processes preferred.
Intermediate proficiency in Microsoft Excel (pivot tables, VLOOKUP) and Word (policy documentation).
Ability to run and interpret trip-level and provider performance reports.
Familiarity with scheduling and dispatch platforms for trip assignment optimization.
Competence in using data analysis tools for KPI tracking and VoM analytics.
Basic knowledge of AP processes and assembling billing evidence packages.
Familiarity with provider portals and/or dispatching software.
Strong analytical and documentation skills for audits, billing investigations, and compliance.
Strong communication skills for policy interpretation and provider coaching.
Ability to build effective relationships with providers, facilities, and internal teams.
Problem-solving skills to resolve trip-level issues and operational challenges under time constraints.
High adaptability and organizational skills for managing multiple priorities in a fast-paced environment.
Attention to detail to ensure accurate documentation and compliance readiness.
Proven ability to collaborate with cross-functional teams, including AP, Finance, and Operations.

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location:

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)

Pay Range: USD $80,059.20 - USD $106,059.20 /Yr.

Apply Now

Refine Your Search

claims representative jobs in san bernardino ca

Supervisor, Transportation Network Management

Business Office Assistant

DQA Representative

DQA Representative

Claims: Customer Service Representative

Workers' Compensation Claims Adjuster - III

Patient Account Representative

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

Electronic Services Representative

Customer Service Representative - State Farm Agent Team Member

Claims Associate - Workers Compensation | Ontario, CA

Provider Service Representative

Certified Medical Biller and Coder

Field Site Inspector

Property Claims Specialist Field I

Revenue Recovery Analyst

Collector

Provider Dispute Resolution Specialist

Customer Service Representative - State Farm Agent Team Member

Property Claims Specialist Field II

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