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Claims Rep Jobs in Santa Rosa, CA (NOW HIRING)

Odyssey

Senior Claims Specialist

Napa, CA

$100K - $140K/yr

The Senior Claims Specialist is responsible for managing all aspects of complex third-party liability claims, including class actions and high exposure matters, from inception through conclusion ...

Redwood Credit Union

Insurance Representative

Napa, CA · On-site

$69K - $87K/yr

Redwood Credit Union is looking for an Insurance Representative, who will provide inside insurance ... Complete worksheets to facilitate insurance quotes and product claims. Provide consistent, accurate ...

Redwood Credit Union

Insurance Representative

Napa, CA · On-site

$69K - $87K/yr

Redwood Credit Union is looking for an Insurance Representative, who will provide inside insurance ... Complete worksheets to facilitate insurance quotes and product claims. * Provide consistent ...

Redwood Credit Union

Insurance Representative

Napa, CA · On-site

$69K - $87K/yr

Redwood Credit Union is looking for an Insurance Representative, who will provide inside insurance ... claims. • Provide consistent, accurate, and timely communication to insureds through, verbal ...

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All JobsClaims Rep JobsClaims Rep Jobs in Santa Rosa, CA

Claims Rep information

See Santa Rosa, CA salary details

$12

$26

$45

How much do claims rep jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for claims rep in Santa Rosa, CA is $26.38, according to ZipRecruiter salary data. Most workers in this role earn between $19.95 and $29.95 per hour, depending on experience, location, and employer.

What is the difference between Claims Rep vs Claims Adjuster?

AspectClaims RepClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance licensesHigh school diploma; state licensing often required; certifications like AIC or CPCU beneficial
Work EnvironmentOffice setting, customer service interactions, administrative tasksField or office-based, investigating claims, inspecting damages
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, public adjusting firms
Common Search & ComparisonClaims Rep vs Claims Adjuster

Claims Reps primarily handle customer service, processing claims, and administrative duties within insurance companies. Claims Adjusters focus on investigating claims, inspecting damages, and determining claim validity. While both roles require insurance knowledge and sometimes similar certifications, Claims Adjusters typically perform more fieldwork and damage assessments, whereas Claims Reps focus on customer interactions and claim processing.

What cities near Santa Rosa, CA are hiring for Claims Rep jobs?

Cities near Santa Rosa, CA with the most Claims Rep job openings:

Claims Rep jobs near you
Infographic showing various Claims Rep job openings in Santa Rosa, CA as of August 2026, with employment types broken down into 1% Internship, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 79% Physical, 5% Hybrid, and 16% Remote job distribution, with an average salary of $54,863 per year, or $26.4 per hour.

Claims Examiner II

Santa Rosa, CA

Partnership HealthPlan of California
Insurance Services • 501 - 1,000 employees
Learn more about Partnership HealthPlan of Californiaexternal

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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