Claims Examiner - MUST live in COLORADO to be considered.
Primary Location Aurora, Colorado
Worker Location Remote
Job Number 1286776 Date posted 07/31/2024
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Description:
Essential Responsibilities:
SEIU Local 105 - *$26.99 - $30.70
“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.
“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.
Basic Qualifications:
Experience
- 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
Primary Location: Colorado,Aurora,Waterpark I
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 04:30 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: C01|SEIU|Local 105
Job Level: Individual Contributor
Department: Waterpark I - National Claims Service Org
Pay Range: $26.99 - $30.7 / hour
The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
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. Submit Interest
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. Submit Interest
