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Claims Adjuster

Kaiser Permanente

Remote · USJobSeen 1 day agoSeen in employer's feed 1 day ago

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At a glance

Compensation
No compensation found
Location
Remote · US
Work Authorization
Not specified

Olive lists jobs from US employers, including remote roles you can work from the United States.

Job overview

The Claims Adjuster reviews medical claims and determines payment and benefits, researching medical appropriateness, diagnosis, coordination of benefits, fraud and abuse, and third-party liability. The role has an authorization limit of $9,999 per claim and escalates higher claims to a lead or supervisor. It also supports timely processing, regulatory compliance, and department improvements. Remote work is available for candidates who reside in Southern California.

Skills & qualifications

RequiredNice to have

Skills

Medical Claims Processing, requiredTechnical Research, requiredClaims System OCPS, requiredWindows NT, requiredMicrosoft Word, requiredMicrosoft Excel, requiredLotus Notes, requiredCommunication, requiredMedical Terminology, requiredCPT Coding, requiredICD-9 Coding, requiredHCPCS Coding, requiredCOB/TPL/WC, requiredMedical Claims Adjudication, required

Qualifications

3+ Years Medical Claims Processing, requiredHigh School Diploma or GED, requiredMedical Terminology Certificate, nice to have

Full job description

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.

Basic Qualifications:

Experience

  • Three (3) to five (5) years Medical claims processing experience in a HMO/Indemnity environment including technical research and analysis experience.

  • Claims System OCPS; Windows NT; Word, Excel, Lotus Notes. Excellent skills in communication Medical Claims Processing.

  • CPT, ICD-9, Medical Terminology, COB/TPL/WC

  • Demonstrate ability to utilize Medical Terminology and International Classification

  • Diagnosis (ICD-9), HCPCS&CPT coding at a level appropriate to the job.

Education

  • High School Diploma/GED

License, Certification, Registration

  • N/A

Additional Requirements:

Preferred Qualifications:

    • Medical Terminology Certificate Preferred

  • Medical claims adjudication experience required-- billing is not a substitute for paying claims.

Notes:

  • Remote available; must reside in SoCal

  • If ten (10) hour option chosen, shift will be 6:00 am-4:30 pm, back up 8 hour shift will be 8am-430pm

COMPANY: KAISER

TITLE: Claims Adjuster

LOCATION: Downey, California

REQNUMBER: 1435111

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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

How this job compares

Set against the 1,068 open Claims Adjuster jobs on Olive Jobs, counted November 10, 2026.

Pay
  • This postingNot listed
  • California median$80–103K/yr28 salary ranges
  • US median$20–30/hr39 hourly ranges
Openings
Olive Jobs lists 35 open Claims Adjuster jobs in California and 1,068 across the US. 20% of them nationwide are listed as remote or flexible.
Hiring the most in California
Experience
This posting asks for at least 3 years of experience; Claims Adjuster postings that state a minimum ask for 4 years at the median (989 postings).
Education
This posting asks for a high school diploma; 410 of the 1,068 open Claims Adjuster jobs (38%) ask for a high school diploma or higher.

Counted across the open, public US postings on Olive Jobs on November 10, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.

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