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Healthcare Claims Jobs in Riverside, CA (NOW HIRING)

LSMA Management Inc

Claims Manager

San Bernardino, CA · On-site

$87K - $97K/yr

Bachelor's degree in Healthcare Administration, Business Administration, or related field. Experience Minimum: At least five years of managed care claims processing experience. Two or more years of ...

LSMA Management Inc

Claims Manager

San Bernardino, CA · On-site

$87K - $97K/yr

Bachelor's degree in Healthcare Administration, Business Administration, or related field. Experience Minimum: At least five years of managed care claims processing experience. Two or more years of ...

LSMA Management Inc

Claims Manager

San Bernardino, CA · On-site

$87K - $97K/yr

Bachelor's degree in Healthcare Administration, Business Administration, or related field. Experience Minimum: At least five years of managed care claims processing experience. Two or more years of ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

Two years of healthcare claims processing or claims adjudication experience, including experience interpreting benefits and reimbursement rules. Experience working with claim denials, adjustments ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

Two years of healthcare claims processing or claims adjudication experience, including experience interpreting benefits and reimbursement rules. Experience working with claim denials, adjustments ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

Two years of healthcare claims processing or claims adjudication experience, including experience interpreting benefits and reimbursement rules. Experience working with claim denials, adjustments ...

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All JobsHealthcare Claims JobsHealthcare Claims Jobs in Riverside, CA

Healthcare Claims information

See Riverside, CA salary details

$12

$25

$43

How much do healthcare claims jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for healthcare claims in Riverside, CA is $25.17, according to ZipRecruiter salary data. Most workers in this role earn between $19.04 and $28.61 per hour, depending on experience, location, and employer.

What are healthcare claims?

Healthcare claims are formal requests submitted by healthcare providers or patients to insurance companies for payment of medical services rendered. These claims contain details about the patient, the services provided, diagnosis codes, and the associated costs. The insurer reviews the claim to determine if the services are covered under the patient's policy and then reimburses the provider or patient accordingly. Efficient processing of healthcare claims is essential to ensure timely payment and smooth operation within the healthcare system.

What are common challenges faced by professionals in healthcare claims processing, and how can they be managed effectively?

Healthcare claims professionals often encounter challenges such as navigating complex insurance policies, handling high volumes of claims, and resolving discrepancies between providers and payers. Staying organized and detail-oriented is essential, as is keeping up with evolving regulations and coding updates. Effective communication skills are also important for collaborating with providers, patients, and insurance representatives to resolve issues quickly and accurately. Many organizations provide ongoing training and use technology to streamline workflows, which can help claims professionals manage these challenges successfully.

What are the key skills and qualifications needed to thrive as a healthcare claims specialist, and why are they important?

To thrive as a Healthcare Claims Specialist, you need a solid understanding of medical billing, insurance policies, coding systems (like ICD-10 and CPT), and typically a high school diploma or associate degree in a related field. Familiarity with claims management software, electronic health records (EHRs), and sometimes certification such as Certified Professional Coder (CPC) is valuable. Attention to detail, analytical thinking, and effective communication are essential soft skills for resolving discrepancies and working with providers and insurers. These skills and qualifications ensure accurate claims processing, reduce errors, and help organizations maintain compliance and timely reimbursement.

What is the difference between Healthcare Claims vs Medical Billing Specialist?

AspectHealthcare ClaimsMedical Billing Specialist
CertificationsTypically requires knowledge of insurance policies and claims processingRequires understanding of billing procedures and coding
Work EnvironmentInsurance companies, healthcare providers, claims processing centersMedical offices, hospitals, billing companies
Primary ResponsibilitiesSubmitting and managing insurance claims, ensuring reimbursementCreating patient bills, coding diagnoses and procedures, managing accounts

Healthcare Claims professionals focus on submitting and managing insurance claims to ensure reimbursement, often working directly with insurance companies. Medical Billing Specialists handle creating patient bills, coding medical procedures, and managing billing accounts. While both roles require knowledge of healthcare documentation and insurance processes, Healthcare Claims roles are more centered on claims submission and reimbursement management, whereas Medical Billing Specialists focus on billing accuracy and patient invoicing.

What does a healthcare claims specialist do?

A healthcare claims specialist reviews and processes insurance claims to ensure accurate billing and reimbursement. They verify patient information, coding accuracy, and compliance with insurance policies, often using claims processing software. Strong attention to detail and knowledge of medical coding and insurance regulations are essential for this role.

What cities near Riverside, CA are hiring for Healthcare Claims jobs?

Cities near Riverside, CA with the most Healthcare Claims job openings:

Healthcare Claims jobs near you
Infographic showing various Healthcare Claims job openings in Riverside, CA as of August 2026, with employment types broken down into 2% As Needed, 67% Full Time, 17% Part Time, and 14% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $52,351 per year, or $25.2 per hour.

Claims Manager

San Bernardino, CA • On-site

LSMA Management Inc
See more jobs at LSMA Management Incexternal

$87K - $97K/yr

Full-time

Re-posted 10 days ago

Job description

Description

JOB SUMMARY:

The Claims Manager is responsible for overseeing the daily operations, performance, and regulatory compliance of the Claims Department within the Managed Services Organization (MSO). This role provides leadership and supervision to Claims Examiners and ensures the accurate, timely, and compliant adjudication of professional and institutional claims in accordance with health plan contracts, regulatory requirements, and organizational policies.

The Claims Manager monitors claims inventory, production, and quality metrics, ensures adherence to turnaround time standards, and supports operational efficiency and compliance with federal and California regulatory requirements, including Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS), and Department of Health Care Services (DHCS) requirements where applicable.

This position plays a critical role in ensuring claims processing accuracy, maintaining provider satisfaction, protecting organizational financial integrity, and supporting delegated managed care operations.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS:


Education/Training

Minimum: High School diploma or equivalent required.

Preferred: Bachelor's degree in Healthcare Administration, Business Administration, or related field.


Experience 

Minimum: At least five years of managed care claims processing experience. Two or more years of supervisory or leadership experience. Experience processing professional and institutional claims.

Preferred: Experience in MSO, IPA, or delegated managed care environment. Experience with Medicare, Medi-Cal, Commercial, and managed care claims. Experience with claims systems such as EZ Cap, EPIC, or similar platforms. Experience supporting regulatory and delegation audits.


Certification(s)

Preferred: Certified Professional in Healthcare Quality (CPHQ)


Skills, Knowledge & Abilities

Strong knowledge of managed care claims processing and adjudication.

Knowledge of CPT, HCPCS, ICD-10, and UB-04 claim processing standards. 

Knowledge of DMHC, CMS, DHCS, and managed care regulatory requirements.

Strong leadership and staff supervision skills.

Strong analytical, organizational, and problem-solving skills.

Ability to assess workload and staffing requirements. 

Excellent written and verbal communication skills.

Proficiency in Microsoft Office Suite, including Excel. 

Ability to manage multiple priorities in a deadline-driven environment.

Ability to maintain confidentiality and data integrity.

Ability to collaborate effectively with internal and external stakeholders.


PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or hybrid office environment and involves prolonged periods of sitting, computer use, and data review. The role requires sustained concentration, analytical thinking, and attention to detail to ensure claims accuracy and regulatory compliance. Occasional lifting of materials up to approximately 10-20 pounds may be required. The position may require extended work hours or weekend work to meet operational and regulatory deadlines.


PAY RANGE  

$87,360 - $97,760 / annually 

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