Job Information
Kaiser Permanente OHS Claims Processor I in San Marcos, California
Job Summary:
Under direct supervision, Provides patient/visitor reception; check in and out; cash handling appointment scheduling; and
other Occupational Health Services duties clerical duties as directed. Obtains employer/carrier information for
billing/reporting purposes; contact employers/carriers to obtain authorization for treatment or report status of claims. Review
of records to identify potential billing opportunities and transfer charges to appropriate account, if applicable. Enter pertinent
claim information into KP internal computer systems. Ordering and photocopying medical records; temporarily cover other
desk/functions due to vacation and workload fluctuations; clears designated Health Connect work queues daily, creates
patient accounts to register patients and fills in the required KP computerized systems,; provides personalized and
professional patient/employer/carrier services. Individual must be customer service oriented. Extensive contact with
members, non-members, physicians, third party administrators/carriers and employers/clients. Must be able to provide
status of claim; create patient accounts and files; Input and maintain information on all appropriate systems as utilized by
Kaiser Permanente. Requires excellent interpersonal skills and the ability to multitask in a busy environment.
Essential Responsibilities:
Answer and screen incoming phone calls for the department. Receives and filters messages to
providers/clinicians/case managers/case coordinators through the Health Connect system and reply as
appropriate. Greet patients/visitors and determine nature of visit. Handles customer inquires. Assists
patients in completing required forms. Request for internal /external records. Creates accounts in the
KP internal systems. Transfer charges to the appropriate KP Health Connect patient account.
Schedule appointments for workers compensation patients. Interact with internal/external customers to
schedule appointments or obtain information. Make rounds to certain internal departments to retrieve
paperwork, as necessary. Consolidate or corrects duplicate accounts by using appropriate system
functions. Enters account notes on patient cases. Reviews subpoena requests. Review KP internal
systems to ensure that duplicate visits are not captured. Complete transfer of care forms. Clear
designated Health Connect work queues daily.
Open and distribute mail to proper areas; match bills to reports and mail to carrier along with any other
documentation as necessary. Type various documentation as required in our current KP systems.
Prepare office supply orders. Payment and collection for OHSS services, as required. Performs other
related duties as required to maintain efficient departmental operations. Promotes, ensures and
improves customer service to internal/external customers by demonstrating skills which are consistent
with the organizations philosophy of providing extraordinary customer relationsand quality service as well as all other Kaiser Permanente Policy Procedures.
Basic Qualifications:
Experience
Typing 35 wpm required. All testing must be completed by the end of posting period.
Minimum of one (1) year relevant clerical and customer service experience in Workers Compensation. Successfully passed
a medical terminology test.
Knowledge of Workers Compensation claims Processing. Cash handling experience. Ability to research, summarize and
communicate clearly to the public, both verbally and in writing. Ability to use computer to perform assigned duties.
EQUIPMENT UTILIZED:
Computer
Adding Machine
Fax Machine
Photocopier
Telephone
Typewriter
Education
High school diploma/GED.
License, Certification, Registration
N/A
Additional Requirements:
Preferred Qualifications:
COMPANY: KAISER
TITLE: OHS Claims Processor I
LOCATION: San Marcos, California
REQNUMBER: 1272622
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.