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Claims Processing Manager Jobs in California (NOW HIRING)

Molina Healthcare

Adjuster, Claims

Long Beach, CA · On-site

$17.50 - $21.50/hr

Required Qualifications At least 1 year of claims processing experience in a managed care setting, or equivalent combination of relevant education and experience. Data entry and research skills.

LSMA Management Inc

Claims Examiner

San Bernardino, CA

$28.85 - $33.65/hr

... processed accurately, timely, and in compliance with federal and California requirements. The Claims Examiner collaborates with Provider Relations/Network, Contracting, Utilization Management ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

... processed accurately, timely, and in compliance with federal and California requirements. The Claims Examiner collaborates with Provider Relations/Network, Contracting, Utilization Management ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

... processed accurately, timely, and in compliance with federal and California requirements. The Claims Examiner collaborates with Provider Relations/Network, Contracting, Utilization Management ...

Insperity

Medical Claims Examiner

CA · On-site +1

$24 - $30/hr

Solid knowledge of Medicare and Medi-Cal managed care claims processing and compliance guidelines. * Experience with CPT-4, ICD-10-CM, RBRVS, ASA, and HCPCS, as well as an in-depth understanding of ...

LIBERTY DENTAL

Claims Referral Specialist II

Tustin, CA · On-site +1

Process dental claims, referrals, pre-authorizations, and related transactions within established ... The ability to manage workload efficiently while meeting production and quality expectations. Work ...

Insperity

Medical Claims Examiner

Los Angeles, CA · On-site +1

$24 - $30/hr

Solid knowledge of Medicare and Medi-Cal managed care claims processing and compliance guidelines. * Experience with CPT-4, ICD-10-CM, RBRVS, ASA, and HCPCS, as well as an in-depth understanding of ...

Insperity

Medical Claims Examiner

Los Angeles, CA · On-site +1

$24 - $30/hr

Solid knowledge of Medicare and Medi-Cal managed care claims processing and compliance guidelines. * Experience with CPT-4, ICD-10-CM, RBRVS, ASA, and HCPCS, as well as an in-depth understanding of ...

Molina Healthcare

Senior Examiner, Claims

Long Beach, CA · Remote

$18.50 - $23.50/hr

... processing errors. Manages a caseload of claims - procures all medical records and statements that support the claim. Makes recommendations for further investigation and/or resolution of claims.

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Showing results 41-60

All JobsClaims Processing JobsClaims Processing Manager JobsClaims Processing Manager Jobs in California

Claims Processing Manager information

See California salary details

$34.5K

$86.7K

$137.2K

How much do claims processing manager jobs pay per year?

As of Aug 11, 2026, the average yearly pay for claims processing manager in California is $86,711.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,100.00 and $103,600.00 per year, depending on experience, location, and employer.

What are the primary challenges faced by a claims processing manager, and how can they be addressed?

Claims Processing Managers often navigate challenges such as ensuring timely and accurate claim adjudication, managing a team with varying workloads, and staying up to date with regulatory changes. Balancing efficiency with compliance requires strong organizational skills and effective communication. Successful managers foster a collaborative environment, implement regular training, and leverage technology to streamline processes, all while maintaining high standards of customer service and data integrity.

What does a claims processing manager do?

A Claims Processing Manager oversees the team responsible for reviewing, evaluating, and processing insurance claims. Their duties include ensuring claims are handled efficiently and accurately, developing procedures to improve workflow, and maintaining compliance with industry regulations. They also resolve complex or escalated claims issues, provide staff training, and report on performance metrics. The role requires strong leadership, analytical skills, and attention to detail to ensure a fair and timely claims process.

What are the key skills and qualifications needed to thrive as a claims processing manager?

To thrive as a Claims Processing Manager, you need expertise in insurance claims procedures, analytical skills, and a solid understanding of regulatory compliance, often supported by a bachelor's degree and relevant industry experience. Familiarity with claims management software, workflow automation tools, and data analysis systems is typically required. Strong leadership, attention to detail, and effective communication are crucial soft skills that set top performers apart in this role. These abilities ensure accurate and efficient claims processing, regulatory adherence, and effective team management, all of which are vital for organizational success.
What are the most commonly searched types of Claims Processing jobs in California? The most popular types of Claims Processing jobs in California are:
What cities in California are hiring for Claims Processing Manager jobs? Cities in California with the most Claims Processing Manager job openings:
Claims Processing Manager jobs near you

Senior Claims Auditor (External Audit)

Astrana Health, Inc.

Monterey Park, CA • Remote

$70K - $80K/yr

Full-time

Posted 4 days ago

Job description

Description
Job Title: Senior Claims Auditor
Department: Ops - Claims Ops
 
About the Role:
We are currently seeking a highly motivated Senior Claims Auditor. This role will report to the Director - Claims and enable us to continue to scale in the healthcare industry. 

What You'll Do
  • Analyze and audit Health plan claims selections for all health plan/DMHC/CMS audits 
  • Review samples provider by clerical staff and ensure claims payments are accurate and all documentations required by the health plan auditor are present at the time of audit 
  • Requires the ability to communicate and analyze claims processing methodologies according to CMS and DMHC guidelines 
  • Respond to preliminary results by the due dates 
  • Requires the ability to respond to the corrective action plan timely and address the root cause appropriately as well as remediate the deficiency 
  • Apply claim processing experience to audit and analyze all levels of claims processing procedures and workflows 
  • Handle complex and urgent audit projects from external provider and internal departments 
  • Assist the Recovery Specialist in corresponding with external providers regarding Claims Overpayment requests Audit Documentation/Reconciliation 
  • Accurately document the underpayments and overpayments into the audit database 
  • Assist management with analyzing Claim error trends 
  • Independently run reports on errors identified for potential error trends and report the results to Claims management and Claims Trainer Collaboration 
  • Build and maintain productive & collaborative intradepartmental relationships with department leads (UM, CM, Pharmacy, Eligibility, Performance Programs, Accounting/ Finance, Compliance, Configuration, Network Management, IT Ops, etc.) to enable effective and timely problem/improvement identification & resolution 
  • Identify training needs/ gaps for the team and ensure timely and effective training is imparted to all team members

Qualifications
  • A High School Diploma or Equivalent 
  • At least 2 years of experience as Medical Claims Auditor and 5 years previous experience examining Claims 
  • Solid understanding of the Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS) rules and regulations governing claims adjudication practices and procedures required 
  • Detail knowledge and understanding of Industry pricing methodologies, such as Resources-Based Relative Value Scale (RBRVS), Medicare/Medi-Cal fee schedule, All Patient Refined Diagnosis Related Groups (AP-DRG), Ambulatory Payment Classifications (APC), etc 
  • Detail knowledge of Medi-Cal, Medicare, Medicaid, and Commercial program guidelines 
  • Possess working knowledge of NCQA, DHS and HCFA standards 
  • Knowledge of medical terminology combined with detail knowledge and experience with CPT, HCPCS, DRG, REV, OPS, ASC, ICD10, CRVS, RBRVS, CMS, ICE for Health Plan, DMHC and DHS fee schedules and CMS Medicare regulatory agencies, COB and Third-Party Liability recovery 
  • Must have the ability to analyze and process all levels of claims accurately utilizing advanced level knowledge of CMS and DMHC Regulations 
  • Must possess the ability to effectively present information and respond to questions from managers, employees, customers 
  • Must possess advanced reasoning and problem-solving abilities and planning skills 
  • Ability to multi-task, prioritize and work in a fast-paced environment under minimal supervision 
  • Proficient in Excel to include the ability to create and revise Excel spreadsheets to provide accurate and clear reports 
  • Strong independent decision-making, influencing and analytical skills 
  • Extensive knowledge of claims processing guidelines including, perspective payment systems, DRG payment systems, comprehensive coding edits, Medicare guidelines, and Medi-Cal guidelines 
You’re great for the role if: 
  • Bachelor’s degree preferred 
  • Have experience using Ez-Cap and/or IDX

Environmental Job Requirements and Working Conditions
  • This position is remotely based in the U.S. The home office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754. 
  • The target pay range for this role is between $70,308.00 - $80,000.00. 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.