Insurance & Reimbursement Specialist

TEKsystems; United States; Remote; USD 30,000 - 32,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) retirement plan

Life Insurance

Disability

HSA

Paid time off

Job summary

TEKsystems is seeking a contract Healthcare Payer Specialist to provide subject matter expertise on medical and prescription insurance coverage, verification, and prior authorization processes. You will assist physician offices and patients through documentation and filing, monitor status for rapid turnaround, and collaborate with payors and providers to verify benefits.

The role requires experience in healthcare reimbursement, prior authorization, denials/appeals, and call center environments,

Qualifications

• 2–5 years of work experience in a healthcare or reimbursement setting.
• Must have thorough understanding of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and denials/appeal filings, and specialty pharmacy operations.
• Skilled with the Microsoft Office suite and able to learn other computer systems.
• 5+ years of healthcare call center experience with inbound and outbound calls.

Responsibilities

• Provide subject matter expertise on medical and prescription insurance coverage, verification, claim billing, prior authorization and appeal filing, and alternate financial assistance opportunities.
• Assist offices through the documentation and filing process for prior authorizations and appeals; monitor status for rapid turnaround.
• Use internal and web tools to communicate with payors and providers to verify benefits and maintain payor intelligence resources.
• Decide whether to reinvestigate or accept obtained benefit verification; escalate issues to management when needed; participate in quality monitoring.
• Enter patient demographic and health insurance information into the hub information system and notify the physician of incomplete or incorrect data.

Skills

Healthcare knowledge

Microsoft Office

Call center experience

Job description

Job Description

• Provide subject matter expertise on medical and prescription insurance coverage/ verification claim billing medication prior authorization and appeal filing and alternate financial assistance opportunities. Accurately documents information in the appropriate systems and formats. Communicate the status of the referral to the physician and the patient via phone fax and/or the core pharmacy system as per established policies and procedures.
• Assist offices through the entire documentation and filing process for prior authorizations and appeals. Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient.
• Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits. Obtain and confirm information to maintain Pharmacy Solutions payor intelligence resources.
• Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalare issues/concerns to management for review guidance and resolution. Participate in quality monitoring and in identifying and reporting quality issues.
• Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information

Qualifications

• 2-5 years of work experience in a healthcare or reimbursement setting. Previous experience in a healthcare office, corporate setting, healthcare insurance provider or pharmacy is highly desirable.
• Must have thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and denials/appeal filings, and specialty pharmacy operations.
• Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems
• 5+years of healthcare call center experience with inbound and outbound calls

#centralpriority26

Job Type & Location

This is a Contract position based out of Chicago, IL.

Pay and Benefits

The pay range for this position is $22.00 - $23.00/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 jobclassification and length of employment. Benefits are subject to change and may besubject to specific elections, plan, or program terms. If eligible, the benefitsavailable 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)

Application Deadline

This position is anticipated to close on Nov 8, 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.