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Claims Risk Management Jobs in California (NOW HIRING)

City of Gardena, CA

Risk Management Analyst

Gardena, CA · On-site

$89K - $114K/yr

... business administration, risk management, or a closely related field; AND two years of ... Work closely with outside claims administrators. * Investigate or assist in the investigation of ...

City of Gardena

Risk Management Analyst

Gardena, CA · On-site

$89K - $114K/yr

... business administration, risk management, or a closely related field; AND two years of ... Work closely with outside claims administrators. Investigate or assist in the investigation of ...

Chumash Enterprises

Risk Manager

Santa Ynez, CA · On-site

The Risk Manager manages all facets of the risk management function, including insurance, claims ... Responsible for claims management from reporting to final closure of all claims. * Establishes and ...

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Claims Risk Management information

See California salary details

$34.5K

$86.7K

$137.2K

How much do claims risk management jobs pay per year?

As of Sep 12, 2026, the average yearly pay for claims risk management 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 is claims risk management?

Claims Risk Management refers to the process of identifying, evaluating, and mitigating risks related to insurance claims. Professionals in this field analyze claim trends, investigate potential fraud, and implement strategies to reduce the frequency and severity of claims. Their goal is to protect the financial interests of the insurer while ensuring fair treatment of policyholders. Effective claims risk management helps companies minimize losses and improve operational efficiency.

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

To thrive in Claims Risk Management, you need a solid understanding of insurance policies, risk assessment, and claims processing, often supported by a degree in business, finance, or insurance-related fields. Familiarity with claims management systems, data analytics tools, and relevant certifications such as AIC or CPCU is highly valuable. Strong analytical thinking, attention to detail, and effective communication are essential soft skills for evaluating claims and collaborating with stakeholders. These competencies ensure accurate risk evaluation, minimize financial loss, and maintain compliance within an organization.

What are some common challenges faced in a claims risk management role, and how can they be addressed?

Professionals in Claims Risk Management often face challenges such as balancing the need for thorough claim investigations with the pressure to resolve cases quickly, staying updated on changing regulations, and detecting potential fraud. To address these challenges, it's important to develop strong analytical skills, maintain open communication with legal and underwriting teams, and participate in ongoing industry training. Building collaborative relationships within the organization also helps streamline processes and foster a proactive approach to risk mitigation.

What is the difference between Claims Risk Management vs Claims Adjuster?

AspectClaims Risk ManagementClaims Adjuster
Primary FocusIdentifying and mitigating risks to prevent claimsInvestigating and settling individual insurance claims
CertificationsRisk management certifications (e.g., CRM, ARM)Adjuster licenses and certifications
Work EnvironmentOffice-based, strategic planningFieldwork, claims sites, or office
Industry UsageInsurance companies, risk management firmsInsurance carriers, third-party claims companies

Claims Risk Management professionals focus on reducing overall claim risks through analysis and strategy, while Claims Adjusters handle individual claims, investigating and settling them. Both roles are essential in the insurance industry but serve different functions.

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

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

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

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

What cities in California are hiring for Claims Risk Management jobs?

Cities in California with the most Claims Risk Management job openings:

Claims Risk Management jobs near you
Infographic showing various Claims Risk Management job openings in California as of September 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $86,711 per year, or $41.7 per hour.

RN, Manager, Risk Management (Roseville)

Roseville, CA • On-site

Adventist Health
Non-Profits • 10K+ employees
Learn more about Adventist Healthexternal

$103K - $155K/yr

Full-time

Posted 4 days ago

Adventist Health rating

7.7

Company rating: 7.7 out of 10

Based on 247 frontline employees who took The Breakroom Quiz

Job description


Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Is responsible for facilitating and implementing existing risk management program to be consistent with the established philosophies and procedures of the organization. Provides day-to-day technical leadership while performing escalated or complex duties; responding to risk-related issues and complaints involving the organization and its affiliates; manages and analyzes risk management information data; conducts risk management in-services and education; collaborates with appropriate departments in activities that aim to prevent, mitigate and reduce risk; coordinates communication, disclosure, and early resolution after a safety event; collaborates and supports Claims team in managing the organization's insurance program; interfaces with internal and external legal defense counsel; and complies with risk management standards for purposes of accreditation, regulatory, and statutory compliance with the objective of promoting and enhancing patient and employee safety, evidence based and safe care, and minimizing losses to protect the assets and reputation of the organization. Supports subject matter experts in review and development of policies and procedures related to nursing, clinical practice and risk management and is a resource to Risk teams.
Job Requirements:
Education and Work Experience:
  • Bachelor's Degree or equivalent combination of education/related experience: Required
  • Two year's leadership experience: Required
  • Three years' experience in healthcare or general risk management: Required
  • Three years' nursing experience: Required

Licenses/Certifications:
  • Certified Professional in Healthcare Risk Management (CPHRM): Required within two years of hire
  • Registered Nurse (RN) license in the state of practice: Required

Essential Functions:
  • Reviews events and complaints that pose organizational risk and assists in appropriate responses. Participates in patient safety event review meetings and completes necessary follow up. Initiates review of events with high harm and potentially compensable events (PCEs).
  • Participates in activities designed to reduce risk exposure and improve safe patient care (e.g. Cause Analysis, Failure Mode Effects Analysis (FMEA) and performance improvement teams). Contributes and participates in risk assessments as needed to proactively identify and evaluate areas of risk. Acts as a liaison and resource to assess risk exposures in specific clinical and other situations (e.g. Facilities, Safety, Nursing, Pharmacy, Security, and Patient Relations). Works with Safety, Procurement, and Clinical Engineering and Clinical Operations to identify medical device and equipment failures for purposes of improving organizational risk, patient safety and for reporting to the Food and Drug Administration (FDA). Participates as member of various organizational councils/committees to provide risk management perspective and input for purposes of reducing organizational risk and promoting safety activities.
  • Contributes to the investigations and analysis of potential and actual general and professional liability claims filed against Adventist Health facilities, employees, and medical staff in conjunction with Claims team, and Legal department. Utilizes clinical expertise to review related clinical information (e.g. medical record, relevant medical literature); participates in interviews with individuals involved; named parties, and/or other clinical experts. Participates in all aspects of claims process which includes but is not limited to: coordination of depositions; response to interrogatories; requests for production of evidence; ensuring documentation and data management. Ensures timely and accurate response to inquiries for claims history and coverage information. Monitors evidence preservation (e.g. surveillance video, equipment, etc, and/or litigation holds). Attends trial as site representative as directed by internal and external legal counsels. Recommends payment for replacement of lost property after claims evaluation. In collaboration with Claims team and internal and external legal counsels, negotiates settlement of small claims within administrative authority and advises billing department of appropriate action for unpaid accounts involved in litigation . Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery
  • Collaborates with Director of Risk Management in developing risk management program, policies and procedures and enhances existing risk management programs, policies, and procedures consistent with established organizational philosophies and values. Supports the periodic review and monitoring of risk management programs and solutions. Maintains a network of informational sources and experts, performs risk surveys, inspects patient care areas and reviews facilities to assess loss potential.
  • Partners with various departments to analyze data (e.g. complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education. Utilizes external data (local, state, national) to identify high-risk topic areas and focus groups for targeted education. Offers risk educational program on a regular basis and as requested including organization-wide presentations as well as specialty specific.
  • Performs other job-related duties as assigned.

Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
About Us
Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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