Claims Adjuster
Kaiser Permanente
Downey, CA · Posted November 6, 2026
Just laid off? Start here: a plan for the first weeks
See every open role at Kaiser Permanente
More in California job market · All Claims Adjuster jobs (42) · Healthcare & Hospital Systems
More roles at Kaiser Permanente
- Medical Imaging Engineer III - Computed Tomography (CT) · Clackamas, OR
- Lead Clinical Laboratory Scientist · San Marcos, CA
- Director, Clinical / Service Delivery, Laboratory Equipment
- Director, Patient Financial Services - MHS · Wailuku, HI
- Nurse Director, Hospital - Perioperative Services · Hillsboro, OR
- Director, Quality & Safety Oversight, Clinical Quality Oversight · Portland, OR
Similar jobs
- Claims Examiner · Prime Healthcare · Victorville, CA
- Senior Liability Claims Adjuster (Senior Claims Adjuster) · Crawford & Company · CA
- Advanced Disability Claims Analyst · Ameriprise Financial · Minneapolis, MN
- Claims Analyst III - EPL and D&O · American International Group · NY
- Claims Specialist III · American International Group · Atlanta, GA
- Senior Claims Adjuster · Brown & Brown · Plano, TX
How AI is used in this kind of work
AI use among claims adjusters, examiners, and investigators is little observed so far. Measured exposure for claims adjusters, examiners, and investigators: 8% (little observed).
Share of this job’s tasks that AI is already used for at work, from real usage. It is not a forecast of job loss, and a low number means no use seen yet. Source: Anthropic Economic Index.
About the job
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.