Claims Processor

TEKsystems; Appleton (WI); Remoto; USD 22.000 - 31.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental & vision

401(k) Retirement Plan

Time Off/Leave (PTO)

HSA

Descrizione del lavoro

TEKsystems seeks a detail-focused Claims Analyst II for our healthcare claims operations. You will review and process professional and institutional claims, ensure coding accuracy, and resolve complex reimbursements to meet quality standards.

Ideal candidates have 2–4 years in healthcare claims processing, strong analytical skills, and familiarity with CPT/ICD-10 coding. This remote role supports the US healthcare ecosystem with competitive benefits.

Competenze

• Minimum 2–4 years in healthcare claims processing/claims administration.
• Experience reviewing and adjudicating both professional and facility medical claims.
• Strong knowledge of healthcare reimbursement practices and claims payment methodologies.

Mansioni

• Review professional and institutional claims per plans and guidelines.
• Determine outcomes: payment, denial, adjustment, or review.
• Verify accuracy, coding, and supporting documentation.
• Ensure timely, accurate payments per service standards.
• Handle COB, workers' comp, and subrogation claims.
• Communicate with providers, members, and internal teams to resolve issues.

Conoscenze

Claims processing

Medical terminology

Coding (CPT/ICD-10)

COB knowledge

Subrogation procedures

Claims software

Analytical skills

Formazione

High school diploma or GED

Strumenti

QNXT

Healthcare claims platforms

Descrizione del lavoro

Claims Analyst II Healthcare Claims Specialist

Join Our Team as a Claims Analyst II!

We are looking for a knowledgeable and detail-focused Claims Analyst II to support our healthcare operations team. In this role, you will evaluate, process, and resolve medical claims while ensuring compliance with benefit plans, healthcare regulations, and internal policies. The ideal candidate has experience in health insurance claims administration, strong analytical skills, and a solid understanding of medical billing and coding practices.

Key Responsibilities

• Review and process professional and institutional healthcare claims according to benefit plans and organizational guidelines.
• Evaluate claims to determine appropriate outcomes, including payment approval, denial, adjustment, or additional review.
• Verify claim accuracy, coding compliance, and supporting documentation.
• Ensure timely and accurate claim payments in accordance with established service standards.
• Research and resolve claims requiring additional review, clarification, or correction.
• Handle Coordination of Benefits (COB), Workers Compensation, and subrogation-related claims.
• Identify processing discrepancies and make appropriate system updates or claim adjustments.
• Review high-dollar claims and authorize payments within designated authority levels.
• Apply contractual reimbursement methodologies and network discounts during claim review.
• Communicate with providers, members, and internal departments to obtain required information and resolve claim issues.
• Maintain complete and accurate records of claim decisions, adjustments, and payment activities.
• Process specialized claims, including transplant and complex reimbursement cases.
• Meet departmental productivity, quality, and turnaround-time expectations.
• Stay informed on changes to benefit plans, provider contracts, medical policies, and regulatory requirements.

Required Qualifications

• High school diploma, GED, or equivalent combination of education and experience.
• Minimum 2-4 years of experience in healthcare claims processing or claims administration.
• Experience reviewing and adjudicating both professional and facility medical claims.
• Working knowledge of healthcare reimbursement practices and claims payment methodologies.
• Strong understanding of:
• Medical terminology
• CPT, ICD-9, and ICD-10 coding
• Coordination of Benefits (COB)
• Subrogation procedures
• Healthcare claims regulations and guidelines
• Ability to interpret insurance plan documents, certificates of coverage, and medical policies.
• Excellent analytical, organizational, and problem-solving abilities.
• Proficiency using healthcare claims processing platforms and related software applications.

Preferred Qualifications

• Experience working with QNXT or similar healthcare claims systems.
• Background supporting Medicaid, ACA, Managed Care, Medicare, or commercial health plans.
• Medical coding experience and/or industry certifications.
• Knowledge of provider reimbursement methodologies, fee schedules, discounts, and claim repricing processes.
• Experience handling complex claim reviews and payment investigations.

Why Join Us?

• Opportunity to work within a dynamic healthcare insurance environment.
• Collaborative team culture focused on quality and service excellence.
• Professional growth and development opportunities.
• Meaningful work that contributes to positive member and provider experiences.

Job Type & Location

This is a Contract to Hire position based out of Appleton, WI.

Pay And Benefits

The pay range for this position is $19.25 - $19.25/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms.

• Medical, dental & vision
• Critical Illness
• Accident, and Hospital
• 401(k) Retirement Plan
• Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Application Deadline

This position is anticipated to close on Nov 3, 2026.

Workplace Type

This is a fully remote position.

About TEKsystems

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.