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Medical Claims Processor Jobs in California (NOW HIRING)

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 ... medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or ...

TEKsystems

Claims Processor

Escondido, CA · On-site

$21/hr

In this role, you will be responsible for processing medical record requests accurately, efficiently, and in compliance with HIPAA regulations and company policies. The ideal candidate is dependable ...

TEKsystems

Claims Processor

Escondido, CA

$21/hr

In this role, you will be responsible for processing medical record requests accurately, efficiently, and in compliance with HIPAA regulations and company policies. The ideal candidate is dependable ...

KHS

Claims Examiner I/II - Temporary

Bakersfield, CA · On-site

$22 - $23.10/hr

About the role Under management direction, responsible for reviewing and processing all types of medical and facility claims from contracting and non-contracting providers and from subscribers and ...

Managed Staffing

Claims Examiner

Whittier, CA · On-site

$30 - $32/hr

The ideal candidate will have experience adjudicating medical claims, including UB-92 and HCFA-1500 forms, and must demonstrate thorough knowledge of HMO claims processing for PHP-affiliated medical ...

KabaFusion

EDI Medical Claims Coordinator

Cerritos, CA · On-site

$23 - $26/hr

Why do EDI Medical Claims Coordinators want to work here? The reason people love working for ... Process and adjudicate claims, resolving any data discrepancies or missing information * Build and ...

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All JobsMedical Claims Processor JobsMedical Claims Processor Jobs in California

Medical Claims Processor information

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$13

$19

$25

How much do medical claims processor jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for medical claims processor in California is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $17.07 and $21.35 per hour, depending on experience, location, and employer.

What is a medical claims processor?

Medical claims processors work for a health care office or insurance company. Their job is to check medical insurance claims for proper billing codes, update the doctor or insurer about changes to the claim, and clarify concerns about patient benefits. It is essential that the billing codes match the medical services provided. As a medical claims processor, you also follow up with the insurer to discuss discrepancies and find out the status of claims. Current procedural terminology (CPT) and data entry are central parts of a medical claims processor’s job, as they often use Microsoft Office applications or a secure database to enter billing codes for services rendered.

What does a medical claims processor do?

A Medical Claims Processor is responsible for reviewing, evaluating, and processing health insurance claims submitted by policyholders or healthcare providers. Their main tasks include verifying patient and insurance information, examining medical codes, ensuring compliance with insurance policies, and determining the amount payable for each claim. They play a crucial role in making sure that claims are handled efficiently and accurately, helping both providers and patients navigate insurance benefits. Attention to detail, knowledge of medical terminology, and understanding insurance guidelines are essential skills for this role.

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

To thrive as a Medical Claims Processor, you need a solid understanding of medical terminology, health insurance policies, and claims adjudication processes, often supported by a high school diploma or associate degree. Proficiency with claims management software, ICD and CPT coding systems, and electronic health record systems is typically required. Attention to detail, organizational skills, and the ability to communicate clearly with providers and patients are essential soft skills. These competencies ensure accurate claim processing, minimize errors, and help maintain efficient workflow within healthcare administration.

What are some common challenges faced by medical claims processors, and how can they be managed?

Medical Claims Processors often encounter challenges such as handling complex insurance policies, keeping up with changing regulations, and resolving claim discrepancies. To manage these issues, strong attention to detail, continuous learning, and effective communication with providers and insurance representatives are essential. Many processors also rely on updated software and regular training to stay current with industry standards and maintain accuracy in claim adjudication.

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

AspectMedical Claims ProcessorMedical Billing Specialist
CredentialsHigh school diploma; certification optionalHigh school diploma; certification often preferred
Work EnvironmentHealthcare offices, insurance companiesMedical offices, billing companies
Primary FocusReviewing and processing insurance claimsCreating and sending bills to patients and insurers
Common TasksVerifying claim accuracy, data entryCoding procedures, invoicing patients

While both roles involve handling healthcare financial data, Medical Claims Processors focus on reviewing and submitting insurance claims, whereas Medical Billing Specialists handle invoicing and billing patients. Both roles require attention to detail and knowledge of healthcare billing processes, but their daily tasks and focus areas differ.

Do you need a degree to be a medical claims processor?

A degree is not typically required to become a medical claims processor, but employers often prefer candidates with a high school diploma or equivalent. Relevant skills include knowledge of medical billing, coding, and claims processing software, and some positions may offer on-the-job training or certification programs.
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For Medical Claims Processor jobs in California, the most frequently searched job titles are:

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Medical Claims Processor jobs near you
Infographic showing various Medical Claims Processor job openings in California as of August 2026, with employment types broken down into 80% Full Time, 15% Part Time, and 5% Temporary. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $39,963 per year, or $19.2 per hour.

Medical Claims Examiner

Cornerstone Staffing Solutions Inc

Fremont, CA • Remote

$41.85/hr

Full-time, Contractor

Re-posted 14 days ago

Job description

Work Location: Fremont, California
Employment Type: Full-Time
Hourly Pay Rate: $41.85 per hour
Schedule: Monday through Friday | 8 hour shifts - 8:30 am to 5:00 pm.
Contract to hire

Position Overview
Cornerstone Staffing Solutions is seeking an experienced Medical Claims Examiner for a full-time opportunity with an established healthcare benefits administration organization in Fremont, California.
The Medical Claims Examiner will review, analyze, and adjudicate healthcare claims in accordance with applicable benefit plans, policies, contracts, regulatory requirements, and internal processing guidelines. This position requires a strong understanding of medical claims, benefit interpretation, healthcare coding, coordination of benefits, and claims payment methodologies.
The successful candidate will be highly accurate, organized, and comfortable working in a structured, production-oriented environment. This individual must be capable of balancing claim-processing productivity with quality, compliance, and professional service to members, providers, and internal departments.

Primary Responsibilities
  • Review and adjudicate professional and institutional medical claims accurately and within established turnaround times.
  • Verify member eligibility, effective dates, benefit coverage, and applicable plan provisions.
  • Review claims for completeness, accuracy, coding consistency, and required supporting documentation.
  • Interpret medical benefits, exclusions, limitations, deductibles, copayments, coinsurance, out-of-pocket maximums, and other cost-sharing requirements.
  • Examine CPT, HCPCS, ICD-10-CM, revenue, place-of-service, and modifier information as applicable to the claim.
  • Determine appropriate payment, denial, pend, or request-for-information actions.
  • Apply coordination-of-benefits guidelines and determine primary and secondary payer responsibilities.
  • Identify duplicate claims, billing discrepancies, possible overpayments, and other processing concerns.
  • Review claims involving prior authorization, medical necessity, timely filing, eligibility, and benefit limitations.
  • Research complex claims using benefit documents, internal procedures, provider contracts, and available claim history.
  • Request medical records, corrected claims, itemized bills, or other supporting documentation when necessary.
  • Document all research, claim decisions, adjustments, and communications clearly within the claims-processing system.
  • Process corrected claims, reconsiderations, adjustments, and reprocessed claims according to established procedures.
  • Communicate professionally with healthcare providers, members, and internal teams to resolve claim-related questions.
  • Assist with appeals, escalated claims, and complex benefit inquiries as assigned.
  • Meet established productivity, accuracy, quality, and attendance expectations.
  • Protect confidential member and health information in accordance with HIPAA and organizational policies.
  • Participate in training, quality reviews, departmental meetings, and process-improvement initiatives.
  • Perform additional claims-related duties as assigned.

Common Claims and Services Reviewed
The Medical Claims Examiner may review claims involving:
  • Physician and specialist services
  • Primary and preventive care
  • Urgent care and emergency services
  • Inpatient and outpatient hospital care
  • Surgical and procedural services
  • Diagnostic imaging