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Kaiser Permanente Careers

Insurance & Claims

Delivery You Can Count On

As a member of our Claims Connect team, you'll help process and deliver the claims information Kaiser Permanente's members, providers, regulators, and customers need, and expect, from a world-class health care organization.

Claims & Referral Processor II - Temporary Position

Location: Englewood, CO Additional Locations:
Job Number: 781564 Date posted: 03/29/2019
Description:

Provides technical assistance to Claims Examiners. Participates in external and internal audits, provides training to new/current staff, and completes additional projects. Assist leadership by providing feedback on training and other assigned duties. Makes members/region and their needs a primary focus of one's actions; develops and sustains productive member/patient relationships. Actively seeks information to understand member/region circumstances, problems, expectations, and needs. Builds rapport and cooperative relationship with members/region. Considers how actions or plans will affect members; responds quickly to meet member/region needs and resolves problems.



Essential Responsibilities:

  • For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills.

  • Understand and apply county, state and federal regulations.

  • 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.

  • Provides assistance to prepare materials as needed to leads, supervisors and managers for external audits.

  • Communicate problems and/or trends to leads and management.

  • Work with claim systems and management to assign work

  • Attend and actively participate in meetings at request of management

  • Prepare HD claim submissions to ensure accuracy and timeliness

  • Effectively communicate with staff and management

  • Support the NCA training program by participating in training activities, answering claims related questions that staff raise, and serve as a subject matter expert relating to processes/procedures.

  • May train as necessary


  • Other duties as assigned within department job functions.

  • Basic Qualifications:

    Experience

  • Minimum four (4) years of claims adjudication experience.

  • Education

  • High School Diploma or General Education Development (GED) required.

  • License, Certification, Registration

  • N/A



  • Additional Requirements:

  • Basic PC skills

  • Working knowledge of Microsoft Word

  • Ability to do basic math (addition, subtraction, multiplication). Math assessment with Proficiency Level: (2.51 - 3.50)

  • 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

  • Knowledge of medical terminology and international classification of Disease (ICD-10) and Current Procedure Terminology (CPT). Proof of certification or passing score required.

  • Skills in analysis, interpretation and application of procedures, practices and methods used in claims adjudication without direct supervision or oversight



  • Preferred Qualifications:

  • N/A
  • Primary Location: Colorado,Englewood,Meridian - Englewood MSSA 9800 S. Meridian Blvd. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 4:30 PM Job Schedule: Full-time Job Type: Standard Employee Status: Temporary Employee Group/Union Affiliation: SEIU - Local 105 Job Level: Individual Contributor Job Category: Insurance / Claims Department: NCA Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About Insurance & Claims Careers

    Careers in Insurance & Claims

    Our insurance and claims teams are committed to meeting customer and member expectations when it comes to the timely and accurate processing of claims, while remaining in compliance with federal, state, and local laws, as well as regulations and rules. Make an impact as you contribute to the implementation of contemporary technology in areas such as claims quality, claims operations, business analysis, processing, configuration, reporting, and more.

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