Claims Processor - Wisconsin Residents Only

Davita Inc.; Menasha (WI); Remote; USD 1,000; Full time

Job summary

A leading healthcare provider is seeking a Claims Analyst II to efficiently process healthcare claims while ensuring compliance with policies. The position offers remote flexibility, competitive pay, and opportunities for growth as the company expands its services. Ideal candidates will showcase experience in healthcare claims processing with a strong attention to detail.

Benefits

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

Employee Assistance Program

Time Off/Leave

Qualifications

• 1.5+ years of healthcare claims processing experience required.
• Experience with COB processing and subrogation.
• Ability to work independently in a remote setting.

Responsibilities

• Review and process professional and facility claims.
• Determine appropriate action on claims: return, pend, deny, or pay.
• Investigate and resolve pending claims within established timeframes.

Skills

Attention to detail

Knowledge of CPT and ICD-9/10

Claims processing

Medicaid and/or Medicare knowledge

COB processing

Education

High school diploma or equivalent

Job description

Claims Processor - Wisconsin Residents Only

Life insurance, sick time, 401(k), retirement plan

About the Role
We are seeking a detail-oriented and experienced Claims Analyst II to join our growing team. In this role, you will be responsible for examining and processing both paper and electronic healthcare claims. You'll play a key part in ensuring accurate adjudication and timely resolution of claims, while maintaining compliance with policies and confidentiality standards.

Key Responsibilities

1. Review and process professional and facility claims in accordance with member coverage and medical policies.
2. Determine appropriate action on claims: return, pend, deny, or pay.
3. Ensure claims meet billing standards and are complete.
4. Investigate and resolve pending claims within established timeframes.
5. Identify and adjudicate claims involving COB, Workers Compensation, and Subrogation.
6. Maintain departmental quality and turnaround standards.
7. Review claims for re-pricing and apply internal/external discounts.
8. Process specialty claims (e.g., transplant, COB, URN) and document all relevant claim information.
9. Stay current on group contracts, provider discounts, and utilization policies.
10. Perform other duties as assigned.

Schedule: Monday-Friday | 8:00 AM-4:30 PM or 8:30 AM-5:00 PM

Employment Type: Full-Time

Department: Claims Processing

Required Qualifications

• High school diploma or equivalent (preferred).
• 1.5+ years of healthcare claims processing experience.
• Strong knowledge of CPT, ICD-9/10, and medical terminology, Medicaid and/or Medicare.
• Experience with COB processing and subrogation.
• High attention to detail and ability to work independently in a remote setting.

Why Join Us?

• Remote Flexibility: Work from home with a consistent weekday schedule.
• Growth Opportunity: Expand as we prepare to launch a Medicaid line of business in January 2026.
• Impactful Work: Ensure accurate and timely healthcare claim processing that affects patient care and provider satisfaction.

Ready to bring your claims expertise to a mission-driven team? Apply now and help us deliver exceptional service to our members and providers.

Pay and Benefits

The pay range for this position is $19.25 per hour. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may include:

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

Workplace Type: This is a fully remote position.

Application Deadline: This position is anticipated to close on Jun 13, 2025.

About TEKsystems and TEKsystems Global Services

We're a leading provider of business and technology services, helping accelerate business transformation. Our expertise in strategy, design, execution, and operations unlocks business value through a range of solutions. We are a team of 80,000 working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe, and Asia. We are committed to building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

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, or any characteristic protected by law.