Kaiser Permanente · 1 day ago
Claims Adjuster
Downey, CA
Full-time
Onsite
Mid Level
3+ years expKaiser Permanente is seeking a Claims Adjuster to review claims and make payment determinations. The role involves conducting research related to claims processing, ensuring compliance with government regulations, and providing input for departmental improvements.
Health CareHospitalMental HealthNon ProfitPersonal Health
Responsibilities
Reviews claims and makes payment determination with authorization limit to $9,999 per claim
Conducts research regarding medical appropriateness, coordination of benefits issues, fraud and abuse, and third party liability
Checks with Lead and Supervisor for any claim exceeding $9,999
Provides input to Supervisor regarding trends related to training, education to enhance department production and processes
Utilizes knowledge of government regulatory policies and procedures to ensure compliance with government regulations including but limited to CMS, DMHC, DHS and requirements of accrediting agencies such as NCQA
Proactively works to ensure claims are review & processed timely
Qualification
Required
Three (3) to five (5) years Medical claims processing experience in a HMO/Indemnity environment including technical research and analysis experience
Claims System OCPS; Windows NT; Word, Excel, Lotus Notes
Excellent skills in communication Medical Claims Processing
CPT, ICD-9, Medical Terminology, COB/TPL/WC
Demonstrate ability to utilize Medical Terminology and International Classification
Diagnosis (ICD-9), HCPCS&CPT coding at a level appropriate to the job
High School Diploma/GED
Preferred
Medical Terminology Certificate Preferred
Company
Kaiser Permanente
Kaiser Permanente is a health organization that offers disease prevention, mental healthcare, and chronic disease management services.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$7.48M2018-07-17Grant· $0.08M
2014-08-05Grant· $7.4M
Leadership Team
Gregory Adams
Chair and Chief Executive Officer
James L. Robinson III
Senior Vice President/Area Manager
Recent News
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