Current jobs related to Medical Claims Adjudicator II - Walnut Creek, California - Kaiser Permanente

  • Senior Property Claims Investigator Position

    4 weeks ago

    Walnut Creek, California, United States Command Investigations Full time

    At Command Investigations, we are seeking a seasoned Senior Property Claims Investigator to join our team. This is a full-time position with a competitive salary of $75,000 - $90,000 per year, depending on experience.Job Description:As a Senior Property Claims Investigator, you will be responsible for conducting thorough investigations into property claims,...

  • Medical Social Worker II

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job Summary:The Medical Social Worker II plays a vital role in assisting patients and their families/caregivers to cope with the social/emotional issues and practical arrangements related to the patient's illness.Under the general direction of the Social Work Manager/LCSW, this position delivers age-appropriate social work care to patients and their...

  • Medical Billing Specialist

    4 weeks ago

    Walnut Creek, California, United States A Step Above Health Management Systems Full time

    Job Title: In-Office Medical BillerCompany: A Step Above Health Management SystemsLocation:Position Type: Full-Time (40 hours per week, Monday through Friday)About Us:A Step Above Health Management Systems is dedicated to delivering exceptional health management services and support to our clients. Our goal is to provide accurate and efficient medical...

  • Laboratory Assistant II

    1 month ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job Summary:As a Laboratory Assistant II at Kaiser Permanente, you will play a vital role in supporting our clinical laboratory team. Under the direction of the Laboratory Director and Laboratory Manager, you will receive and process specimens, perform clerical tasks, and perform phlebotomy. You may also operate automated or semi-automated test equipment or...

  • Claims Examiner

    4 weeks ago

    Walnut Creek, California, United States Command Investigations Full time

    Job DescriptionWe are seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are looking for individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity,...

  • Senior Membrane Treatment Specialist

    4 weeks ago

    Walnut Creek, California, United States Brown and Caldwell Full time

    Job Summary:Brown and Caldwell is seeking a highly skilled Senior Membrane Treatment Specialist to join our Drinking Water and Reuse Practices as a Subject Matter Expert in membrane technologies.The successful candidate will assist in growing BC's Drinking Water Practice and lead teams to deliver exceptional service to our municipal and private-sector...

  • Staff Nurse II 16/Night NICU Walnut Creek

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job SummaryThe Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.Essential Responsibilities:Performs...

  • Staff Nurse II ICU 28/Night Walnut Creek

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job Summary:The Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. This role requires a high level of expertise in patient care and a strong commitment to delivering exceptional patient outcomes.Essential Responsibilities:Performs assessment/data collection in an...

  • Staff Nurse II NICU Short Hour Evening Walnut Creek

    1 month ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job SummaryThe Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.Essential Responsibilities:Performs...

  • Staff Nurse II Mom Baby Short Hour Night Walnut Creek

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job Summary:The Registered Nurse (RN) II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.Essential...

  • Staff Nurse II 8/Evening NICU III Walnut Creek

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job SummaryThe Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.Key ResponsibilitiesPerforms...

  • Staff Nurse II L&D 28/Night Walnut Creek

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job SummaryThe Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.Essential ResponsibilitiesPerforms...

  • Staff Nurse II 16/Night NICU III Walnut Creek

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job SummaryThe Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.Key ResponsibilitiesPerforms...

  • Insurance Program Director

    4 weeks ago

    Walnut Creek, California, United States Marsh & McLennan Companies, Inc. Full time

    Job Summary:The Client Services Director will be responsible for managing accounts under $20,000 of income. This includes designing the insurance program, marketing the account to insurance carriers, proposing renewal terms to clients, and interacting with clients on their day-to-day service needs.Key Responsibilities:Acts as the initial point of contact for...

  • Staff Nurse II SH L&D Walnut Creek

    1 month ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job SummaryThe Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.Essential Responsibilities:Performs...

  • Staff Nurse II 16/Night NICU III Walnut Creek

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job SummaryThe Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. This role provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.Key ResponsibilitiesPerforms...

  • Director of Special Investigations

    4 weeks ago

    Walnut Creek, California, United States Berkshire Hathaway Homestate Company group Full time

    Job SummaryBerkshire Hathaway Homestate Companies is a leading workers compensation insurance company dedicated to providing compassionate care to injured workers and superior service to our customers. We are seeking a highly skilled and experienced professional to lead our Special Investigations Unit and drive our fraud prevention and detection efforts.Key...

  • Staff Nurse II 8/Evening NICU III Walnut Creek

    1 month ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job Summary:The Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. This role requires a high level of expertise in providing care to patients via the therapeutic use of self, the nursing process, the environment, and instrumentation, and other healthcare team...

  • Human Resources Specialist

    1 month ago

    Walnut Creek, California, United States Mt. San Antonio College Full time

    Job SummaryMt. San Antonio College is seeking a highly skilled Human Resources Analyst to join our team. As a key member of the HR Investigations and ADA Accommodations department, you will be responsible for providing expert advice and support to employees and management on workers' compensation and benefits-related matters.Key ResponsibilitiesInvestigate...

  • Staff Nurse II L&D 28/Night Walnut Creek

    4 weeks ago

    Walnut Creek, California, United States Kaiser Permanente Full time

    Job Summary:The Registered Nurse II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. This position requires a strong commitment to providing high-quality patient care and working collaboratively with the healthcare team to achieve optimal patient outcomes.Essential...

Medical Claims Adjudicator II

1 month ago

Walnut Creek, California, United States Kaiser Permanente Full time
Job Summary:

As a Claims Adjudicator II at Kaiser Permanente, you will play a critical role in ensuring the timely and accurate processing of medical claims. Your expertise in claim processing regulatory guidelines and mandates will be essential in maintaining compliance with departmental and regulatory turn-around time and quality standards.

You will be responsible for reviewing claims and making payment/adjustment determinations, ensuring all components are valid and correct for accurate processing. Your research skills will be utilized to identify errors and take necessary actions to resolve claims, while managing work to meet regulatory guidelines.

Essential Responsibilities:

Reviews claims and makes payment determination with authorization limit to a specific dollar limit.
Checks with Lead and Supervisor for any claim exceeding specific dollar threshold.
Reviews and evaluates claims for proper and correct information, including member, provider, authorization, and billing information.
Refers to eligibility, authorization, benefit, and pricing information to determine appropriate course of action.
Conducts research regarding coordination of benefits issues, fraud and abuse, and third party liability.
Utilizes knowledge of government regulatory policies and procedures to ensure compliance with government regulations.

Requirements:

Three (3) years medical claims adjudication experience.
Experience in processing multiple types of medical claims and lines of business required.
High School Diploma or GED required.
Knowledge of claim processing regulatory guidelines / mandates, ie HIPAA, Timeliness Standards, Medical Terminology, COB / TPL/ WC insurance guidelines.

Preferred Qualifications:

Four (4) years medical claims adjudication experience preferred in processing multiple types of medical claims and lines of business.
Experience with SNF, DME, or Home Care/Hospice Claims processing preferred.
Excellent skills in communication preferred.
Medical Terminology Certificate preferred.