Top 26 Claims examiner Jobs in Santa Ana, Ca

Claims Examiner III
Champion Health Plan is a Medicare Advantage Prescription Drug HMO C-SNP serving Medicare beneficiaries with End-Stage Renal Disease. —Long Beach, CA
- From $29 an hour
- Full-time
- Hybrid work
- Customer service
- Writing skills
- Office
- Health insurance
- Dental insurance
Quick Apply
Claims Examiner
CalOptima —Orange, CA
- Weekends as needed
- Background check
- Microsoft Outlook
- Customer service
- Tuition reimbursement
- Paid time off
4d
Workers Compensation Claims Examiner | Orange, CA
Sedgwick —Orange, CA
- Full-time
- Hybrid work
- Customer service
- Mid-level
- Office
- Health savings account
- Disability insurance
1d
Claims Examiner I
Clever Care Health Plan —Huntington Beach, CA
- $27 - $32 an hour
- Full-time
- Hybrid work
- Background check
- Writing skills
- Office
8d
Workers Compensation Claims Examiner | HYBRID | Orange, CA
Sedgwick —Orange, CA
- Hybrid work
- Background check
- Customer service
- 5 years
- Health savings account
- Disability insurance
Quick Apply
3rd Party Claims Adjuster/Examiner - HYBRID
DB Insurance Co., Ltd. —Anaheim, CA
- $65,000 - $100,000 a year
- Full-time
- Hybrid work
- Google Workspace
- Mid-level
- Office
- Paid holidays
- Health insurance
Senior Claims Examiner - 4850
Athens Administrators —Orange, CA
- $50.29 - $55.87 an hour
- Urgently hiring
- Management
- Bachelor of Science
- Basic math
- Health savings account
- AD&D insurance
Quick Apply
Senior Claims Examiner
Venbrook —Anaheim, CA
- $80,000 - $90,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Paid parental leave
- Paid holidays
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
Senior Claim Examiner I
AmTrust Financial Services, Inc. —Irvine, CA
- $49 - $54 an hour
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
- Dental insurance
Senior Claims Examiner
WESTERN GROWERS ASSURANCE TRUST —Irvine, CA
- $53,667.86 - $69,768.32 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Flexible spending account
Quick Apply
Claims Examiner- Workers Compensation | Brea, CA (Hybrid)
Sedgwick —Brea, CA
- Full-time
- Hybrid work
- 5 years
- Mid-level
- Office
- Health savings account
- Disability insurance
Workers Compensation Claims Examiner III _ Temp
TRISTAR RISK MANAGEMENT —Signal Hill, CA
- $93,600 - $104,000 a year
- Temporary
- Remote
- Microsoft Word
- Writing skills
- Basic math
- Paid holidays
- Disability insurance
Quick Apply
Senior Claims Examiner, Workers' Compensation
Gallagher —Corona, CA
- $71,500 - $102,000 a year
- Remote
- 5 years
- High school diploma or GED
- Bachelor's degree
Workers Compensation Claims Examiner III
TRISTAR RISK MANAGEMENT —Signal Hill, CA
- $90,000 - $100,000 a year
- Full-time
- Remote
- Microsoft Word
- Writing skills
- Basic math
- Paid holidays
- Disability insurance
Quick Apply
Claims Examiner
City of Compton, CA —Compton, CA
- $79,747.80 - $93,499.20 a year
- Full-time
- Anatomy knowledge
- Management
- Writing skills
- Paid holidays
- Disability insurance
Workers Compensation Claims Examiner | REMOTE | Must Live in CA
Sedgwick —Brea, CA
- Full-time
- Hybrid work
- Customer service
- Mid-level
- High school diploma or GED
- Health savings account
- Disability insurance
Claims Examiner - Workers Compensation -| Brea, CA
Sedgwick —Brea, CA
- Full-time
- Customer service
- Bachelor's degree
- Fair chance
- Health savings account
- Disability insurance
Workers Compensation Claims Examiner | Long Beach or Roseville, CA
Sedgwick —Long Beach, CA
- Full-time
- Hybrid work
- Background check
- Customer service
- 5 years
- Health savings account
- Disability insurance
Quick Apply
Workers' compensation Subrogation Examiner
TRISTAR RISK MANAGEMENT —Long Beach, CA
- $29.00 - $31.25 an hour
- Full-time
- Microsoft Excel
- Computer literacy
- Writing skills
Quick Apply

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Claims Examiner III

Champion Health Plan is a Medicare Advantage Prescription Drug HMO C-SNP serving Medicare beneficiaries with End-Stage Renal Disease.
Long Beach, CA

Quick Apply

Job Details

Full-time
From $29 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Healthcare claims management
Medical claims
Medicare
Customer service
Health insurance policy knowledge
ICD-9
Attention to detail
Problem-solving
Medical terminology

Full Job Description

The Senior Claims Examainer is responsible for reviewing and adjudicating complex Facility, ASC or specialty claims submitted via paper or electronically. This role involves advanced administrative, operational, and customer support duties that require independent initiative and judgment. The types of claims include inpatient, coordination of benefits (COB) for high-dollar cases, dialysis, oncology/chemotherapy, home health agency, skilled nursing facility (SNF), hospital exclusions, and claim adjustments. The Claims Examiner III also audits professional claims for accuracy.

Functions & Job Responsibilities

Determine whether to return, deny, or pay institutional claims following organizational policies and procedures.
Conduct end-to-end claims audits to ensure claims are processed accurately according to benefits assignment, applicable contracts, pricing, and configuration rules.
Ensure institutional claims meet compliance guidelines.
Perform claims testing on claims configuration and enhancements.
Focus decisions on methods, tactics, and processes for completing administrative tasks/projects.
Regularly exercise discretion and judgment in prioritizing requests, interpreting and adapting procedures, processes, and techniques, and work under limited guidance due to previous experience and breadth and depth of knowledge of administrative processes and organizational knowledge.
Adjudicate complex professional and institutional claims.
Assist with training and mentoring new team members.
Assist with testing new claim processing procedures or projects.
Meet performance measurement standards for productivity and accuracy.
Adjudicate claim adjustments.
Review and correct claims involving data integrity issues.
Interface with other Champion Payor Solutions Departments, when necessary, regarding claims issues.
Participate in Claims Department Team Meetings and other activities as needed.
Support all department initiatives in improving overall efficiency.
Identify and recommend solutions for error issues as they relate to the pre-payment of claims.
Oversee the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues.
Manage a caseload of various types of complex claims. Procure all medical records and statements that support the claim.
Meet department quality and production standards.
Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business.
Perform other duties as assigned.

Qualifications

Education & Experience:

Associate degree or equivalent combination of experience in health insurance or related fields, which would provide the necessary knowledge, skills, and abilities to successfully perform the work.
Three or more (3 +) years of experience in examining and processing institutional claims for inpatient, dialysis, SNF, and home health using Medicare prices.
Two (2) years of experience in examining and processing medical claims, professional or institutional.
Experience with Medicare/Medi-Cal is preferred.
Experience with claim adjustments, provider appeals, and/or disputes is preferred.

Skills:

Advanced knowledge and skills in medical terminology, HCPCS/CPT, and ICD-9/ICD-10.
Knowledge of Centers for Medicare and Medicaid Services claims payment guidelines.
Strong analytical skills, including the ability to analyze and organize data.
Strong attention to detail.
Excellent organizational, oral presentation, and written and verbal communication skills.
Proficiency in MS Office products, including PowerPoint, Excel, and Word.
Ability to provide effective leadership and direction within an organization.
Meet and consistently maintain production standards for Claims Adjudication.

Job Type: Full-time

Pay: From $29.00 per hour

Benefits:

401(k)
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

claims examiner jobs in santa ana, ca

Claims Examiner III

Claims Examiner

Workers Compensation Claims Examiner | Orange, CA

Claims Examiner I

Workers Compensation Claims Examiner | HYBRID | Orange, CA

3rd Party Claims Adjuster/Examiner - HYBRID

Senior Claims Examiner - 4850

Senior Claims Examiner

Workers' Compensation Claims Examiner

Senior Claim Examiner I

Senior Claims Examiner

Claims Examiner- Workers Compensation | Brea, CA (Hybrid)

Workers Compensation Claims Examiner III _ Temp

Senior Claims Examiner, Workers' Compensation

Workers Compensation Claims Examiner III

Claims Examiner

Workers Compensation Claims Examiner | REMOTE | Must Live in CA

Claims Examiner - Workers Compensation -| Brea, CA

Workers Compensation Claims Examiner | Long Beach or Roseville, CA

Workers' compensation Subrogation Examiner

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