Claims Adjuster
Kaiser Permanente
Downey, CA · Posted November 6, 2026
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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.