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Claims Examiner Jobs in Riverside, CA (NOW HIRING)

LSMA Management Inc

Claims Examiner

San Bernardino, CA

$28.85 - $33.65/hr

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 ...

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Claims Examiner

Pomona, CA · On-site

$27 - $28/hr

Quick2Hire is seeking an experienced Claims Examiner to join our team! Assignment Details * Location: Pomona, CA * Duration: 13 Weeks * Schedule: Full-Time, Day Shift * Shift: Monday - Friday | 8:00 ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

Job Type Full-time Description JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical claims for a management services organization (MSO) supporting medical ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

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 ...

Berkley

Senior Claims Examiner

Irvine, CA · On-site

$400K/yr

Under the supervision of the Vice President of Claims, the Senior Claims Examiner is responsible for managing all aspects of workers' compensation claims, including complex and litigated matters ...

Berkley

Senior Claims Examiner

Irvine, CA

$400K/yr

Responsibilities Under the supervision of the Vice President of Claims, the Senior Claims Examiner is responsible for managing all aspects of workers' compensation claims, including complex and ...

Berkley

Senior Claims Examiner

Irvine, CA · On-site

$400K/yr

Responsibilities Under the supervision of the Vice President of Claims, the Senior Claims Examiner is responsible for managing all aspects of workers' compensation claims, including complex and ...

Venbrook

Senior Claims Examiner

Anaheim, CA · On-site

$69K - $89K/yr

Claims Adjuster, Public Entity DEPARTMENT: Claims Services REPORTS TO: Claims Manager / Director of Claims FLSA STATUS: Exempt COMPANY OVERVIEW Venbrook Claims Services is the claims business group ...

Venbrook

Senior Claims Examiner

Anaheim, CA · On-site

$69K - $89K/yr

Claims Adjuster, Public Entity DEPARTMENT: Claims Services REPORTS TO: Claims Manager / Director of Claims FLSA STATUS: Exempt COMPANY OVERVIEW Venbrook Claims Services is the claims business group ...

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All JobsClaims Examiner JobsClaims Examiner Jobs in Riverside, CA

Claims Examiner information

See Riverside, CA salary details

$16

$30

$47

How much do claims examiner jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for claims examiner in Riverside, CA is $30.67, according to ZipRecruiter salary data. Most workers in this role earn between $23.32 and $36.63 per hour, depending on experience, location, and employer.

How to become a claims examiner?

To become a claims examiner, candidates typically need a high school diploma or equivalent, with some roles preferring postsecondary education or relevant experience in insurance or healthcare. Certification programs, such as the Certified Claims Examiner (CCE), can enhance job prospects. Strong attention to detail, communication skills, and knowledge of insurance policies are important for success in this role.

Is a claims examiner a stressful job?

A claims examiner role can be stressful due to the need to review complex claims accurately and meet deadlines. The job often involves handling difficult cases and making critical decisions, which can contribute to work-related stress, especially in high-volume environments or with tight schedules.

Is claim adjusting a dying field?

Claims examiners play a vital role in the insurance industry by reviewing and processing claims, and demand for these professionals remains steady due to ongoing insurance needs. While automation and AI tools are increasingly used to assist claims processing, the need for human judgment and expertise ensures that claim adjusting continues to be a relevant career, especially for those with strong analytical and communication skills.

What Is a Claims Examiner?

A claims examiner evaluates claim files that have been submitted by an insurance adjuster. They decide whether to authorize or deny payments and refer suspicious or complicated claims to insurance investigators. This job is a risk management position. In health insurance, examiners may have to decide if medical procedures are worth the patient’s prognosis, if someone's cause of death warrants incidental fees, or if witness interviews waive the insurance company’s liability.

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

To thrive as a Claims Examiner, you need strong analytical skills, attention to detail, and a background in insurance, finance, or a related field, often supported by relevant certifications or a degree. Familiarity with claims management software, regulatory compliance systems, and industry-specific databases is typically required. Excellent communication, problem-solving abilities, and good judgment help you stand out in this position. These skills and qualities are crucial for ensuring accurate claim evaluations, minimizing risk, and maintaining customer trust.

What does a Claims Examiner do?

A Claims Examiner is responsible for reviewing insurance claims to determine their validity and whether they should be approved or denied. They carefully examine claim forms, supporting documents, and sometimes conduct interviews to gather additional information. Claims Examiners ensure that claims comply with policy terms and legal requirements, and may calculate the amount to be paid out. Their work helps prevent fraudulent claims and ensures fair processing for all parties involved.

What is the role of a claims examiner?

A claims examiner reviews insurance claims to determine their validity and the appropriate payout based on policy coverage and documentation. They analyze claim forms, investigate discrepancies, and ensure compliance with regulations, often using claims processing software. Strong attention to detail and knowledge of insurance policies are essential for this role.

What are some common challenges faced by Claims Examiners, and how can they be managed effectively?

Claims Examiners often encounter challenges such as reviewing complex or incomplete documentation, managing a high volume of claims, and balancing the need for accuracy with efficiency. Effective organization, strong attention to detail, and clear communication with claimants and other team members are essential for overcoming these obstacles. Additionally, staying current with industry regulations and using claims management software can help streamline the process and reduce errors.

What is the difference between Claims Examiner vs Claims Processor?

AspectClaims ExaminerClaims Processor
Required credentialsHigh school diploma or equivalent; often some insurance or claims experienceHigh school diploma or equivalent; may have basic insurance knowledge
Work environmentOffice setting, reviewing claims, making determinationsOffice setting, processing claims data, data entry
Employer and industry usageInsurance companies, government agenciesInsurance companies, third-party administrators
Common search intentUnderstanding roles, career differences, job requirementsEntry-level position, processing claims, job duties

Claims Examiners review insurance claims to determine coverage and approve or deny payments, requiring analytical skills and some insurance knowledge. Claims Processors handle the data entry and processing of claims, focusing on accuracy and efficiency. While both roles work in insurance settings and may require similar credentials, Claims Examiners have more decision-making responsibilities, whereas Claims Processors focus on data handling.

More about Claims Examiner jobs
What are the most commonly searched types of Claims Examiner jobs in Riverside, CA? The most popular types of Claims Examiner jobs in Riverside, CA are:
What are popular job titles related to Claims Examiner jobs in Riverside, CA? For Claims Examiner jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Claims Examiner jobs in Riverside, CA look for? The top searched job categories for Claims Examiner jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Claims Examiner jobs? Cities near Riverside, CA with the most Claims Examiner job openings:
Claims Examiner jobs near you
Infographic showing various Claims Examiner job openings in Riverside, CA as of July 2026, with employment types broken down into 92% Full Time, 4% Temporary, and 4% Contract. Highlights an 86% In-person, 4% Hybrid, and 10% Remote job distribution, with an average salary of $63,802 per year, or $30.7 per hour.

Claims Examiner

LSMA Management Inc

San Bernardino, CA

$28.85 - $33.65/hr

Other

Posted 14 days ago

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

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