Company Info

Kaiser Permanente

1 Kaiser Plaza
Oakland, CA, United States

Phone: 6788364982
Web Site:

Company Profile

Claims Adjuster


Job ID:



Oakland, CA, United States 

Job Views:


Zip Code:


Employment Type:

Full time



Job Description:

Reviews claims and makes payment and benefit determination.  Conducts research as it relates to claims processing for medical appropriateness, and diagnosis, using ICD-9 codes and CPT codes as required. 
Essential Functions:
• 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.

Job Requirements:

Basic Qualifications:
• Three (3) to five (5) years Medical claims processing experience in a HMO/Indemnity environment including technical research and
analysis experience.
• High School Diploma/GED.
Licenses, Certifications, Registrations
• N/A.
Additional Requirements:
• 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.

If interested, please apply online at
Posting # 533170 or 533175