Claims Processor III (Remote Options)

Date: Jan 15, 2023

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7224 


Position Summary/Position


Under the direction of the Claims Manager and Supervisor, the Claims Processor Level III is responsible for processing complex claims (professional and institutional). This includes but is not limited to; COB high dollar, dialysis, oncology/chemo, hospital exclusions and claim adjustments in an accurate and expedient manner.

Major Functions (Duties and Responsibilities)


1. Adjudicates complex professional and institutional claims.
2. Assist with training and mentoring of new team members.
3. Assist with the testing of new claim processing procedures or projects.
4. Responsible for meeting performance measurement standards for productivity and accuracy.
5. Adjudication of claim adjustments.
6. Review and correct claims involving data integrity issues.
7. Interface with other IEHP Departments, when necessary regarding claims issues.
8. Participate in Claims Department Team Meetings, and other activities as needed.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leading: Self

Experience Qualifications


Three (3) years experience in adjudicating medical claims.

Preferred Experience


Experience in adjudicating medical claims: professional and institutional preferably in and HMO or Managed Care setting. Medicare/Medi-Cal experience preferred.

Education Qualifications


High School Diploma or GED required.

Preferred Education

Professional Certification

Professional Licenses

Drivers License Required


Knowledge Requirement


ICD-9 and CPT coding and general practices of claims processing.

Skills Requirement


Microcomputer skills, proficiency in Windows applications preferred. Eexcellent communication and interpersonal skills, strong organizational skills required.

Abilities Requirement


Professional demeanor.

Commitment to Team Culture


The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions


Data entry involving computer keyboard and screens, filing and copying of records and/or correspondence.

Work Model Location

Physical Requirements

A reasonable salary expectation is between $48,110.40  - $59,425.60, based upon experience and internal equity.


Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles