Healthcare Claims Specialist

TEKsystems; Madison (WI); Remote; USD 22,000 - 31,000; Full time

Benefits offered by this job

Remote work options

Hybrid/onsite flexibility

Comprehensive training program

Stable schedule (Mon-Fri)

Job summary

TEKsystems seeks a detail-oriented Claims Analyst II to review, analyze, and process medical claims in a role that can be remote within Wisconsin, onsite, or hybrid. Candidates must reside in Wisconsin and be able to pick up equipment from Menasha or Brookfield offices.

The role emphasizes accuracy, compliance, and adherence to health plan policies, with a stable Monday-Friday schedule and comprehensive virtual training.

Qualifications

• 2-4 years of medical claims processing experience.
• Knowledge of CPT coding.
• Knowledge of ICD-9 and ICD-10 coding.
• Knowledge of COB (Coordination of Benefits).
• Knowledge of subrogation processes.

Responsibilities

• Process professional and facility medical claims for payment according to plan benefits and policies.
• Review claims for completeness and compliance with billing standards.
• Determine pay/deny/return/pending based on guidelines.
• Investigate and resolve pending claims within timeframes.
• Identify and process COB, workers' compensation, and subrogation claims.
• Monitor claims processing systems and correct errors.
• Process specialty claims (transplant, COB, complex types).
• Review claims for repricing and apply network discounts.
• Document decisions and maintain records.
• Meet department quality and productivity standards; maintain confidentiality.
• Stay updated on benefit plans, provider agreements, and regulations.

Skills

Medical claims processing

CPT coding

ICD-9/10 coding

COB knowledge

Subrogation

Analytical skills

Attention to detail

Independent work

Job description

• Stable Monday-Friday schedule
• Comprehensive virtual training program

About The Opportunity

We are seeking a detail-oriented Claims Analyst II to join our growing team. In this role, you will review, analyze, and process medical claims while ensuring accuracy, compliance, and adherence to established health plan policies and procedures. This position offers the flexibility of working remote within Wisconsin, onsite, or in a hybrid environment.

Important: Candidates must reside in the state of Wisconsin and be able to pick up company equipment from either the Menasha or Brookfield office.

What You’ll Do

• Process professional and facility medical claims for payment according to plan benefits, medical policies, and coverage guidelines.
• Review claims for completeness, accuracy, and compliance with billing standards.
• Determine whether claims should be paid, denied, returned, or pended based on established guidelines.
• Investigate and resolve pending claims within established timeframes.
• Identify and process Coordination of Benefits (COB), Workers' Compensation, and subrogation claims.
• Monitor claims processing systems and correct errors or discrepancies as needed.
• Process specialty claims, including transplant, COB, and other complex claim types.
• Review claims for repricing and apply appropriate network discounts.
• Document claim decisions and maintain accurate records.
• Meet department quality and productivity standards while maintaining confidentiality.
• Stay current on benefit plans, provider agreements, medical policies, and claims processing regulations.

Required Qualifications

• 2-4 years of medical claims processing experience
• Knowledge of:
  • CPT coding
  • ICD-9 and ICD-10 coding
  • Medical terminology
  • Coordination of Benefits (COB)
  • Subrogation processes
• Strong analytical, organizational, and problem-solving skills
• Ability to work independently while maintaining accuracy and productivity
• High attention to detail and commitment to quality

Why Join Us?

• Flexible work environment with remote, hybrid, or onsite options
• Stable Monday-Friday schedule
• Comprehensive virtual training program
• Opportunity to contribute to a growing organization supporting members and providers
• Collaborative team environment focused on quality and customer service

Training & Schedule

• First 6 weeks of training: 8:00 AM - 4:30 PM
• After training, employees may work with their supervisor regarding scheduling flexibility.
• Standard operating hours are between 8:00 AM and 5:00 PM, Monday through Friday.

Job Type & Location

This is a Contract to Hire position based out of Madison, 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. If eligible, the benefits available for this temporary role may include the following: 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)

Job Type & Location

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

Application Deadline

This position is anticipated to close on Nov 4, 2026.

Workplace Type

This is a fully remote position.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

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.

About TEKsystems And TEKsystems Global Services

We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're 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, 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.