Claims Adjuster
- Location
- Downey, CA
- Listed
- Yesterday
Job Summary
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 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.
From Kaiser Permanente's careers page, first listed on Rolev.ai on November 9, 2026. Rolev.ai is not the employer.
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Common questions
Where is the Claims Adjuster job at Kaiser Permanente located?
This Claims Adjuster position at Kaiser Permanente is located in Downey, CA. Always check Kaiser Permanente's application page for specific state eligibility or relocation policies.
How do I apply for the Claims Adjuster position at Kaiser Permanente?
This listing links directly to Kaiser Permanente's application page. You can apply directly on Kaiser Permanente's site, or use Rolev.ai to check your resume fit, generate a zero-hallucination tailored resume and cover letter for this posting, and autofill the application form in 1 click with the Rolev.ai Chrome extension. You always review the form and press Submit yourself.