Senior Claims Research & Resolution Specialist

Kaiser Permanente; Denver (CO); Presencial; USD 70 000 - 100 000; Tempo integral

Resumo da oferta

Kaiser Permanente in Denver seeks a seasoned Research & Resolution Claims Specialist to provide technical assistance to Claims Adjustors, participate in audits, and train staff. You will focus on member needs, resolve complex inquiries, and support improvements in claims processes.

Responsibilities include verifying inquiries per policies, researching claims, documenting determinations, and contributing to training programs.

Qualificações

• 5+ years of medical claims adjudication in an integrated health plan environment.
• At least 2 years processing high complexity adjustments and high-dollar claims.
• Basic PC skills and proficiency with standard office software.
• Working knowledge of Microsoft Word.
• Ability to apply procedures, practices and methods used in claims processing.
• Ability to apply timely and accurate requirements of all state and federal regulatory guidelines.
• Demonstrated complex problem solving and decision making.
• AA degree, accounting or business related (preferred).

Responsabilidades

• Verify the intent of the inquiry and ensure adherence to contractual agreements and pricing as well as government regulations.
• Locate necessary information relevant to the claim and communicate with stakeholders.
• Research services rendered to determine correct processing and denial accuracy; review and address adjustments.
• Document clear case summaries and take next steps to resolve inquiries.
• Provide input on training opportunities and assist with staff education; participate in meetings as requested.

Conhecimentos

Customer service

Communication

Problem solving

Formação académica

High School Diploma or GED

Ferramentas

Microsoft Word

Microsoft Excel

Descrição da oferta de emprego

Kaiser Permanente in Denver seeks a seasoned Research & Resolution Claims Specialist to provide technical assistance to Claims Adjustors, participate in audits, and train staff. You will focus on member needs, resolve complex inquiries, and support improvements in claims processes.

Responsibilities include verifying inquiries per policies, researching claims, documenting determinations, and contributing to training programs.