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Claims Assistant Jobs in Fallbrook, CA (NOW HIRING)

Sedgwick

Claims Team Lead - Workers Compensation

San Diego, CA · On-site +1

$100K - $120K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. * Deliver innovative customer-facing solutions to clients who represent virtually ...

Athens Administrators

Senior Claims Examiner

San Diego, CA · On-site +1

$50.29 - $55.87/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Monitor and assist litigation * Negotiate settlement of claim, liens, rehabilitation plans, etc. * Prepare and present reports to clients * Appropriately close claims * Help resolve client billing ...

Berkshire Hathaway Homestate Companies

Claims Manager

San Diego, CA · On-site

$127K - $153K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Claims Manager establishes and executes claim handling strategies, leverages data and technology to drive performance, ensures adherence to legal and company standards, and fosters a culture of ...

Berkshire Hathaway Homestate Companies

Claims Manager

San Diego, CA · Hybrid

$127K - $153K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Claims Manager establishes and executes claim handling strategies, leverages data and technology to drive performance, ensures adherence to legal and company standards, and fosters a culture of ...

Icwgroup

Triage Claims Associate

San Diego, CA · Hybrid

$18.75 - $25.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

PURPOSE OF THE JOB The Triage Claims Associate for Workers' Compensation plays a critical role in the initial assessment and routing of a claim. This position is responsible for reviewing incoming ...

New

ICW Group

Triage Claims Associate

San Diego, CA · On-site

$18.75 - $25.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

PURPOSE OF THE JOB The Triage Claims Associate for Workers' Compensation plays a critical role in the initial assessment and routing of a claim. This position is responsible for reviewing incoming ...

ICW Group

Triage Claims Associate

San Diego, CA · On-site

$18.75 - $25.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

PURPOSE OF THE JOB The Triage Claims Associate for Workers' Compensation plays a critical role in the initial assessment and routing of a claim. This position is responsible for reviewing incoming ...

New

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All JobsClaims JobsClaims Assistant JobsClaims Assistant Jobs in Fallbrook, CA

Claims Assistant information

See Fallbrook, CA salary details

$14

$22

$29

How much do claims assistant jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for claims assistant in Fallbrook, CA is $22.06, according to ZipRecruiter salary data. Most workers in this role earn between $18.89 and $23.94 per hour, depending on experience, location, and employer.

What are the duties of a claims assistant?

A claims assistant works under the supervision of more senior claims examiners to ensure a claims adjuster and the claimants have followed the proper guidelines for filing claims. You also help adjusters deal with complex cases such as after a natural disaster hits and there are a significant number of claims coming in. As an assistant, you perform a number of administrative and clerical tasks which free examiners up to do other work. These duties include data entry, checking payment paperwork, confirming a claimant’s wage statement, and drafting report and billing paperwork.

What are the key skills and qualifications needed to thrive as a claims assistant, and why are they important?

To thrive as a Claims Assistant, you need strong organizational skills, attention to detail, and a basic understanding of insurance processes, often supported by a high school diploma or equivalent. Familiarity with claims management software, data entry systems, and office productivity tools like Microsoft Office is important. Excellent communication, customer service, and problem-solving skills help you interact effectively with clients and team members. These abilities ensure efficient claims processing, accurate documentation, and a positive customer experience.

How does a claims assistant typically interact with other departments during the claims process?

As a Claims Assistant, you will regularly collaborate with various teams such as adjusters, underwriters, and customer service representatives to ensure that claims are processed accurately and efficiently. Your role often involves gathering necessary documentation, clarifying claim details, and updating records, which requires clear communication and attention to detail. Effective teamwork and the ability to coordinate with different departments are essential, as you may need to follow up on missing information or escalate complex cases to senior staff. This collaborative environment helps ensure that claimants receive timely resolutions and supports the overall workflow of the claims department.

What is the difference between Claims Assistant vs Claims Processor?

AspectClaims AssistantClaims Processor
Required CredentialsHigh school diploma or equivalent; some roles may prefer certifications in insurance or customer serviceHigh school diploma; certifications in insurance claims processing are a plus
Work EnvironmentOffice setting, interacting with clients and insurance agentsOffice or remote, focusing on reviewing and processing claims
Employer & Industry UsageInsurance companies, third-party administrators, and brokersInsurance companies, claims departments, and third-party administrators
Common Search & Comparison IntentUnderstanding entry-level claims roles and responsibilitiesClarifying the specific duties and qualifications of claims processing roles

Claims Assistants typically handle customer inquiries, gather documentation, and support claims processing, while Claims Processors focus on reviewing, evaluating, and approving claims. Both roles often require similar credentials and work in insurance settings, but their responsibilities differ in scope and focus.

What is the role of a claims assistant?

A claims assistant supports insurance claims processing by reviewing claim forms, gathering necessary documentation, and communicating with clients and adjusters. They often use claims management software and need strong organizational and communication skills to ensure accurate and efficient handling of claims. The role may require familiarity with insurance policies and attention to detail.
More about Claims Assistant jobs

What are the most commonly searched types of Claims jobs in Fallbrook, CA?

The most popular types of Claims jobs in Fallbrook, CA are:

What job categories do people searching Claims Assistant jobs in Fallbrook, CA look for?

The top searched job categories for Claims Assistant jobs in Fallbrook, CA are:

What cities near Fallbrook, CA are hiring for Claims Assistant jobs?

Cities near Fallbrook, CA with the most Claims Assistant job openings:

Claims Assistant jobs near you
Infographic showing various Claims Assistant job openings in Fallbrook, CA as of August 2026, with employment types broken down into 1% As Needed, 71% Full Time, 25% Part Time, 1% Temporary, and 2% Contract. Highlights an 98% Physical, 1% Hybrid, and 1% Remote job distribution, with an average salary of $45,890 per year, or $22.1 per hour.

Experienced Claims Adjuster

Berkshire Hathaway Homestate Companies

San Diego, CA • Hybrid

$70K - $90K/yr

Full-time

Medical, Dental, Vision, Life, PTO

Re-posted 22 days ago

Job description

WHAT WE'RE LOOKING FOR
Berkshire Hathaway Homestate Companies has an immediate opportunity for an experienced workers compensation adjuster. We're looking for self-starters who can work under minimum direction, can achieve defined results, and are willing to accept ownership for their work product.
 
This Claims Professional is responsible for the management of a caseload of workers compensation indemnity claims from inception to resolution, performing initial investigation and compensability determination, reserve analysis and strategic planning, timely benefit administration to injured workers, and coordination of medical care and legal process, while maintaining the highest level of service to our insureds.
ESSENTIAL RESPONSIBILITIES
  • Conducts the investigation of reported claims via three-point contact calls to determine coverage, compensability and severity, and to gather all other relevant information, documenting all relevant information thoroughly and escalating the investigation for further investigation when appropriate.
  • Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
  • Calculates and administers benefits in accordance with statutory requirements, including timely issuance of appropriate notices and filings.
  • Develops and updates a Plan of Action for the successful resolution of each claim; timely updates Plan as new information is obtained.
  • Makes prompt, sound decisions on issues that arise in claims based on the best information available, ensuring that work is performed in accordance with Company standards, training, supervisory direction, and applicable laws.  Timely escalates issues/red flags to Supervisor and/or appropriate internal team.
  • Ensures that the actions of all other professionals involved in claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.
  • Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
  • Accurately and thoroughly prepares litigation referrals, AOE/COE investigation referrals, and MSA referrals for submission to vendor; obtains proper approval from Management.
  • Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates settlement of claims.
  • Fosters a positive and close working relationship with partner company staff, including the Call Center, Medical Management, Special Investigations, Client Services, Underwriting, and Claims Legal.
  • Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
  • Collaborates with Adjusting staff and relevant interdepartmental personnel on special projects focused on process efficiency.
  • Ensures continual education requirements are met.
REQUIRED QUALIFICATIONS
  • EDUCATION: Minimum of a High School diploma required or equivalent certificate required; Bachelor's degree from four-year College or university preferred.
  • DESIGNATION: Designated as a Claims Adjuster or Experienced Claims Adjuster per the California Code of Regulations and has completed the minimum required continuing education credits to adjust workers compensation claims for the State of California; Self-Insured certification a plus.
  • EXPERIENCE: Minimum of three years of indemnity adjusting experience managing large and/or complex claims and accounts within a workers' compensation carrier required
  • Maintains qualifying educational criteria to adjust workers' compensation claims for the State of California; Self-Insured certification preferred. 
  • Inquisitive, critical thinker; agile learner with adaptive, smart time management skills.
  • To perform this job successfully, an individual should be proficient in the Microsoft Office Suite of applications (highly proficient in Excel preferred), and be proficient on applicable databases, systems and vendor software programs.
WHAT WE OFFER
  • Work-Life Balance
  • Work From Home Program (up to 2 days per week)
  • Reasonable caseload with in-house Medical Management support (UR, Med Bill Review, Resource Nurses); In-house Claims Assistant support
  • Free On-Site Fitness Facility
  • Free On-Site Garage Parking
  • Paid Time Off
  • Paid Holidays
  • Retirements Savings Match
  • Group Health Insurance (Medical, Dental, and Vision)
  • Life and AD&D Insurance
  • Long Term Disability Insurance
  • Accident and Critical Illness Insurance
  • Flexible Savings Accounts
  • Paid Community Volunteer Day
  • Employee Assistance Program
  • Tuition Reimbursement Program
  • Employee Referral Program
  • Diversity, Equity and Inclusion Program
$70,304 - $95,130 a year
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