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Claims Processing Manager Jobs in Santa Rosa, CA

First American

Claims Advocate Specialist

Santa Rosa, CA · Remote

$20.34 - $27.12/hr

Managing support on inbound rotary to review high priority claims, while resolving multiple ... and process payment requests * Piloting innovative company initiatives Requirements: * Bachelors ...

PEP Housing

Human Resources Manager

Santa Rosa, CA

$80K - $85K/yr

We build and manage affordable housing for seniors living on fixed, limited incomes. Our residents ... claims, and reasonable accommodation processes in collaboration with Insperity and organizational ...

HUB

Account Manager II, Commercial Lines

Napa, CA · On-site

... processing for assigned accounts. Includes acting as Back-up for other support staff members ... Troubleshoots claims and billing issues. * Identifies opportunities for cross-sell and up-sell of ...

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Claims Processing Manager information

See Santa Rosa, CA salary details

$38.3K

$96.1K

$152K

How much do claims processing manager jobs pay per year?

As of Aug 10, 2026, the average yearly pay for claims processing manager in Santa Rosa, CA is $96,061.00, according to ZipRecruiter salary data. Most workers in this role earn between $74,300.00 and $114,800.00 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 cities near Santa Rosa, CA are hiring for Claims Processing Manager jobs? Cities near Santa Rosa, CA with the most Claims Processing Manager job openings:
Claims Processing Manager jobs near you

Claims Examiner II

Partnership HealthPlan of California

Santa Rosa, CA • On-site

Full-time

Re-posted 10 days ago

Job description

Overview

To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claims worksheets. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters, as necessary. Routes and tracks claims requiring review by other staff and departments, and processes when possible. Claims Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience, as well as an ability to process a wider range of claim types.

Responsibilities
  • Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report.
  • Routes claims to appropriate Partnership departments and internal staff for additional review. Follows up and completes claims once response to request has been received.
  • Follows established Partnership policies and procedures, Partnership Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims.
  • Generates claims correspondence as needed.
  • Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor.
  • Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame.
  • Supports Claims Department's needs for resolving all pended claim types.
  • Participates in special projects and assignments as required.
  • Identifies and reports trends of pending claims that are increasing or processes that appear dated.
  • Recognizes and gives feedback to management on procedure changes that would result in more efficient operations.
  • Other duties as assigned.
Qualifications

Education and Experience

High school diploma or equivalent; minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment.

 

Special Skills, Licenses and Certifications

Effective written and oral communication skills. Good organization skills. Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD-10 knowledge preferred.

 

 

Performance Based Competencies

Ability to effectively exercise good judgement within scope of authority and handle sensitive issues with tact and diplomacy. Ability to stay focused on repetitive work and meet production and quality standards. Ability to accurately complete tasks within established timelines. Consistently meets production standards without compromising quality on all tasks.

Work Environment And Physical Demands

Ability to use a microcomputer keyboard. More than 95% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs.

All HealthPlan employees are expected to:

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan's policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 31.45  - $ 37.74

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Employment Type: FULL_TIME

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