ZipRecruiter

Log In

1

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 ...

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 ...

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 ...

Berkley

Senior Claims Examiner

Irvine, CA

$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 ...

Johnson Service Group

Be Seen First

Workers' Compensation Claims Examiner III

Orange, CA · On-site

$50 - $55/hr

Workers' Compensation Claims Examiner III Location: Glendale, CA or Orange, CA Schedule: Hybrid - 3 days onsite Pay Rate: $50-$55 per hour Job Type: W2 Contract Contract Length: 6 months initially ...

New

York Risk Services

Liability Claims Examiner

Riverside, CA · Hybrid

$85K - $105K/yr

... Claims Examiner Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your ...

New

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 ...

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 ...

Sedgwick

Liability Claims Examiner

Orange, CA · Hybrid

$85K - $105K/yr

... Claims Examiner Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your ...

New

Sedgwick

Liability Claims Examiner

Riverside, CA · Hybrid

$85K - $105K/yr

... Claims Examiner Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your ...

New

York Risk Services

Liability Claims Examiner

Orange, CA · Hybrid

$85K - $105K/yr

... Claims Examiner Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your ...

New

next page

Showing results 1-20

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 Aug 12, 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.

Is being a claims examiner hard?

Claims examiners review insurance claims to determine coverage and payment, which can involve detailed analysis and attention to accuracy. The job often requires strong organizational skills, knowledge of policies, and sometimes certification, but the difficulty varies based on experience and the complexity of claims handled.

How much do claims examiners make in the US?

Claims examiners in the US typically earn a median annual salary of around $45,000 to $65,000, depending on experience, location, and employer. Entry-level positions may start lower, while experienced examiners or those with specialized skills can earn higher wages, often supplemented with benefits and opportunities for advancement.

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 do I need to be a claims examiner?

To become a claims examiner, candidates typically need a high school diploma or equivalent, with some roles preferring an associate's or bachelor's degree in fields like insurance, finance, or healthcare. Strong analytical skills, attention to detail, and knowledge of insurance policies and claims processing are essential, along with proficiency in computer software and sometimes relevant certifications such as the Certified Claims Professional (CCP).

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 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 August 2026, with employment types broken down into 88% Full Time, 4% Part Time, 4% Temporary, and 4% Contract. Highlights an 86% In-person, 5% Hybrid, and 9% 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

Full-time

Re-posted 12 hours 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

Apply