Kaiser Permanente
Claims Examiner - Must Reside in Colorado
Kaiser Permanente, Aurora, Illinois, United States, 60505
Claims Examiner - Must Reside in Colorado
Join to apply for the
Claims Examiner - Must Reside in Colorado
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Kaiser Permanente Claims Examiner - Must Reside in Colorado
1 day ago Be among the first 25 applicants Join to apply for the
Claims Examiner - Must Reside in Colorado
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Kaiser Permanente Get AI-powered advice on this job and more exclusive features. SEIU Local 105 - $28.35 - $38.62
May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.
Job Summary
Through comprehensive assessment and analysis, adjudicates managed healthcare claims/bills, authorizations and referrals, for payment or denial within contract agreement and/or regulatory requirements. Performs these duties using industry standard knowledge of managed healthcare claim/bill payment processing and medical regulations, verifies and updates relevant data into various computerized internal and external systems. For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills. Proactive and or responsive outreach to provider, members and other customers that could include phone calls, emails or other methods as needed. Proactively communicate with internal departments as appropriate to resolve claims issues promptly. Provides input to supervisor and training and development team regarding training and educational tools to enhance department production and processes. Proactively communicate with internal departments as appropriate to resolve claims issues promptly. Provides assistance to prepare materials as needed to the leads, supervisors and managers for external audits. Communicate problems and/or trends to leads and management. Understand and apply county, state and federal regulations. Other duties as assigned within department job functions.
SEIU Local 105 - $28.35 - $38.62
May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.
Job Summary
Through comprehensive assessment and analysis, adjudicates managed healthcare claims/bills, authorizations and referrals, for payment or denial within contract agreement and/or regulatory requirements. Performs these duties using industry standard knowledge of managed healthcare claim/bill payment processing and medical regulations, verifies and updates relevant data into various computerized internal and external systems.
Essential Responsibilities
For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills. Proactive and or responsive outreach to provider, members and other customers that could include phone calls, emails or other methods as needed. Proactively communicate with internal departments as appropriate to resolve claims issues promptly. Provides input to supervisor and training and development team regarding training and educational tools to enhance department production and processes. Proactively communicate with internal departments as appropriate to resolve claims issues promptly. Provides assistance to prepare materials as needed to the leads, supervisors and managers for external audits. Communicate problems and/or trends to leads and management. Understand and apply county, state and federal regulations. Other duties as assigned within department job functions.
Experience
Basic Qualifications:
Minimum three (3) years of claims adjudication experience required.
Education
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements
Customer service experience. Basic PC skills required. Working knowledge of Microsoft Word. Ability to work in a in a Labor Management Partnership environment. Ability to understand and meet customer needs in a claims setting. Ability to apply procedures, practices and methods used in claims processing. Skills in analysis, interpretation and application of procedures, practices and methods used in claims adjudication without direct supervision or oversight.
Preferred Qualifications
N/A Seniority level
Seniority level
Mid-Senior level Employment type
Employment type
Full-time Job function
Job function
Finance and Sales Industries
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Join to apply for the
Claims Examiner - Must Reside in Colorado
role at
Kaiser Permanente Claims Examiner - Must Reside in Colorado
1 day ago Be among the first 25 applicants Join to apply for the
Claims Examiner - Must Reside in Colorado
role at
Kaiser Permanente Get AI-powered advice on this job and more exclusive features. SEIU Local 105 - $28.35 - $38.62
May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.
Job Summary
Through comprehensive assessment and analysis, adjudicates managed healthcare claims/bills, authorizations and referrals, for payment or denial within contract agreement and/or regulatory requirements. Performs these duties using industry standard knowledge of managed healthcare claim/bill payment processing and medical regulations, verifies and updates relevant data into various computerized internal and external systems. For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills. Proactive and or responsive outreach to provider, members and other customers that could include phone calls, emails or other methods as needed. Proactively communicate with internal departments as appropriate to resolve claims issues promptly. Provides input to supervisor and training and development team regarding training and educational tools to enhance department production and processes. Proactively communicate with internal departments as appropriate to resolve claims issues promptly. Provides assistance to prepare materials as needed to the leads, supervisors and managers for external audits. Communicate problems and/or trends to leads and management. Understand and apply county, state and federal regulations. Other duties as assigned within department job functions.
SEIU Local 105 - $28.35 - $38.62
May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.
Job Summary
Through comprehensive assessment and analysis, adjudicates managed healthcare claims/bills, authorizations and referrals, for payment or denial within contract agreement and/or regulatory requirements. Performs these duties using industry standard knowledge of managed healthcare claim/bill payment processing and medical regulations, verifies and updates relevant data into various computerized internal and external systems.
Essential Responsibilities
For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills. Proactive and or responsive outreach to provider, members and other customers that could include phone calls, emails or other methods as needed. Proactively communicate with internal departments as appropriate to resolve claims issues promptly. Provides input to supervisor and training and development team regarding training and educational tools to enhance department production and processes. Proactively communicate with internal departments as appropriate to resolve claims issues promptly. Provides assistance to prepare materials as needed to the leads, supervisors and managers for external audits. Communicate problems and/or trends to leads and management. Understand and apply county, state and federal regulations. Other duties as assigned within department job functions.
Experience
Basic Qualifications:
Minimum three (3) years of claims adjudication experience required.
Education
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements
Customer service experience. Basic PC skills required. Working knowledge of Microsoft Word. Ability to work in a in a Labor Management Partnership environment. Ability to understand and meet customer needs in a claims setting. Ability to apply procedures, practices and methods used in claims processing. Skills in analysis, interpretation and application of procedures, practices and methods used in claims adjudication without direct supervision or oversight.
Preferred Qualifications
N/A Seniority level
Seniority level
Mid-Senior level Employment type
Employment type
Full-time Job function
Job function
Finance and Sales Industries
Hospitals and Health Care Referrals increase your chances of interviewing at Kaiser Permanente by 2x Get notified about new Claims Examiner jobs in
Aurora, CO . Denver, CO $130,000.00-$150,000.00 2 days ago If you don't see the job you are looking for Apply Here
Catastrophe Claims Specialist Sr -Denver CO
Denver, CO $76,000.00-$104,500.00 1 day ago Remote Healthcare Call Center Representative
Palantir Field Service Representative (copy)
Denver, CO $75,000.00-$150,000.00 1 month ago Englewood, CO $90,000.00-$140,000.00 2 weeks ago Customer Relations Representative - State Farm Agent Team Member
Greenwood Village, CO $19.57-$31.32 3 days ago Denver, CO $52,500.00-$71,250.00 1 month ago Work From Home - Client Services Representative
Remote Call Center Customer Service Representative
Denver, CO $60,000.00-$74,000.00 2 weeks ago Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr