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Claims Operations Jobs in California (NOW HIRING)

Astrana Health

Lead - Claims Operations

Monterey Park, CA · Hybrid

$27 - $32/hr

We are currently seeking a highly motivated Lead - Claims Operations. This role will report to the Sr. Manager - Claims and enable us to continue to scale in the healthcare industry. This is a hybrid ...

Brookfield

Director, Claims Triage

Los Angeles, CA · On-site

The Director, Claims Triage leads a nationwide triage operation, managing a fast-paced team responsible for the time sensitive intake and accurate routing of workers' compensation, liability, and ...

Raydar

Strategy & Operations

San Francisco, CA · On-site

$100K - $150K/yr

Our client is a 25-person AI-native insurance claims company building technology and operations for a massive global market. The business reached multi-seven-figure annual recurring revenue in under ...

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Claims Operations information

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$12

$23

$42

How much do claims operations jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for claims operations in California is $23.19, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $25.38 per hour, depending on experience, location, and employer.

What is claims operations?

Claims Operations refers to the processes and teams responsible for handling, processing, and managing insurance claims from start to finish. This includes reviewing claims submissions, verifying information, coordinating investigations, and ensuring that claims are settled efficiently and accurately. Claims Operations professionals work to streamline workflows, comply with regulations, and deliver a positive experience for policyholders. Their role is essential in preventing fraud, reducing costs, and maintaining customer satisfaction within an insurance company.

What are the key skills and qualifications needed to thrive in claims operations?

To thrive in Claims Operations, you need strong analytical abilities, attention to detail, and a background in insurance, finance, or a related field. Familiarity with claims management systems, regulatory compliance tools, and industry certifications such as AIC (Associate in Claims) is often required. Excellent communication, problem-solving skills, and adaptability help professionals handle complex claims and interact effectively with clients and stakeholders. These competencies are crucial for ensuring accurate, timely claims processing and maintaining customer satisfaction.

What are some common challenges faced in a claims operations role and how can they be managed?

Professionals in Claims Operations often encounter challenges such as managing high volumes of claims, ensuring accuracy under tight deadlines, and navigating complex regulatory requirements. To manage these effectively, strong organizational skills, attention to detail, and familiarity with claims processing software are essential. Many teams use workflow automation and regular training sessions to stay updated on procedures and compliance standards, which helps streamline operations and reduce errors. Building strong communication skills also aids in collaborating with adjusters, underwriters, and customers to resolve issues efficiently.

What is the difference between Claims Operations vs Claims Adjuster?

AspectClaims OperationsClaims Adjuster
Primary RoleOversees claims processing, manages teams, and ensures compliance across claims functions.Evaluates individual claims, investigates damages, and determines settlement amounts.
Required CredentialsTypically requires claims handling certifications, insurance licenses, and management experience.Requires adjuster licenses, claims handling certifications, and knowledge of insurance policies.
Work EnvironmentOffice-based, team management, and coordination with various departments.Fieldwork and office work, direct interaction with claimants and vendors.
Industry UsageCommonly used in insurance companies for claims processing departments.Used by insurance carriers for claim evaluation and settlement.

Claims Operations focuses on managing the overall claims process and team coordination, while Claims Adjusters handle individual claim evaluations and settlements. Both roles require insurance-related certifications and are integral to the insurance industry, but they differ in scope and daily responsibilities.

Is claims processing a stressful job?

Claims processing is a core part of claims operations and can be stressful due to tight deadlines, high workload, and the need for accuracy. Employees often manage multiple claims simultaneously and must pay close attention to detail, which can contribute to job stress, especially during busy periods or complex cases.

What are the most commonly searched types of Claims Operations jobs in California?

The most popular types of Claims Operations jobs in California are:

What are popular job titles related to Claims Operations jobs in California?

For Claims Operations jobs in California, the most frequently searched job titles are:

What job categories do people searching Claims Operations jobs in California look for?

The top searched job categories for Claims Operations jobs in California are:

Claims Operations jobs near you
Infographic showing various Claims Operations job openings in California as of September 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $48,245 per year, or $23.2 per hour.

Lead - Claims Operations

Monterey Park, CA • On-site

Astrana Health, Inc.
See more jobs at Astrana Health, Inc.external

$27 - $32/hr

Full-time

Re-posted 9 days ago

Job description

Lead - Claims Operations
Department: Ops - Claims Ops
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Nita Alailefaleula
Compensation: $27.00 - $32.00 / hour
Description
We are currently seeking a highly motivated Lead - Claims Operations. This role will report to the Sr. Manager - Claims and enable us to continue to scale in the healthcare industry. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.
What You'll Do
  • Monitor and review work of all Claims Quality, Appeals and Recovery staff to identify additional training needs and to ensure compliance with department quality/production standard
  • Provides performance feedback, as well as identifies developmental opportunities for Claims Quality, Appeals and Recovery staff
  • Monitor and review claims audit and transaction reports. Responsible for identifying claims error trends, implementing controls and changes that will minimize incorrect claims adjudication
  • Coordinate potential recovery efforts with Company Accounting and coordinate potential physician education opportunities with Company Physician Services
  • Work closely with other Company departments to ensure that all areas supporting claims meet appropriate claims quality goals
  • Ensures that all legal, regulatory and policy requirements are met by keeping informed of changes and by implementing necessary controls and/or programs to meet requirements
  • In collaboration with the Claims QA and Training Specialist, claims lead, responsible for ensuring that Claims Representatives have a thorough understanding of Company claims adjudication policies and procedures
  • Coordinate provider contract, health plan benefit/DOFR and system rules configuration testing with Business Applications Configuration team
  • Responsible for ensuring accurate reporting and timely submission of quarterly PDR timeliness reports
  • Work with the Company departments on implementing controls to minimize claims overpayments and identify physician education opportunities with Network Management
  • Work closely with other Company departments and specifically, the Claims QA and Training Specialist to communicate findings of recovery audits and to facilitate accurate adjudication of claims

Qualifications
  • Bachelor's degree in a relevant field or equivalent combination of education and progressively responsible experience
  • At least 5 years of claims experience working for either a Medical Group, IPA, MSO, or Health Plan
  • Advanced knowledge of and working experience with healthcare coding conventions such as ICD-10, CPT, and HCPCS
  • Thorough knowledge of medical claim processing procedures/systems, auditing, and a thorough understanding of claim protocols, industry standards and CMS regulations as it relates to claims payment and compliance
  • Knowledge of claims processing systems configuration and architecture, which will facilitate troubleshooting of claims transaction related issues

You're great for the role if:
  • Have EZ Cap knowledge

Environmental Job Requirements and Working Conditions
  • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr, Monterey Park, CA 91754.
  • The target pay range for this role is between $27.00 - $32.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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