Medical Claims Analyst

TEKsystems; Raleigh (NC); Remote; USD 60,000 - 80,000; Full time

Job summary

TEKsystems is seeking a fully remote Medical Claims Analyst to analyze and correct medical claims for a Pharmacy Benefit Manager (PBM). Ideal candidates will have at least 2 years of claims experience focused on research and auditing, along with knowledge of medical terminology. This role involves client and pharmacy remediation analysis, claims monitoring, and employing data science techniques to validate errors and reprocess claims.

Benefits

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Employee Assistance Program

Paid Time Off (PTO)

Qualifications

• 2+ years of claims experience with emphasis on researching/auditing.
• Experience with claims software, particularly RxClaims, preferred.
• Understanding of medical terminology like copays and deductibles is advantageous.

Responsibilities

• Perform client, member, and pharmacy remediation analysis.
• Conduct claims monitoring and data validation activities.
• Research and analyze errors in the RxClaim processing system.

Skills

Researching

Auditing

Data Analysis

Medical Terminology

Tools

RxClaims

Claims Software

Job description

TEKsystems is hiring for a fully remote Medical Claims Analyst for a PBM to help analyze and correct medical claims!!

Start Date: July 14th

Must Haves

2+ years of claims experience with emphasis on researching / auditing not processing or production

Description

Claims software experience with RxClaims being preferred

This role is responsible for performing basic and intermediate level client, member and pharmacy remediation analysis caused by errors coded into the RxClaim processing system, along with claims monitoring and data validation activities. The research and remediation steps can vary based on the issue so this person must be very thorough and detailed. Research and analyze information by employing analytics and data science techniques to research and validate errors, isolate impacted claims, reprocess claims, and determine financial impact to members, health plans and/or pharmacies; translate data into usable client facing reports. The more research and auditing experience they have the more they will succeed in this role. The understanding of medical terminology (Copays, deductibles, and benefit plans) will help them in this role.

Shift

4-5 weeks of training Monday-Friday, 8am-4:30pm CST; after training you can pick your start time of 7am-9am CST

Pay And Benefits

The pay range for this position is $24.00 - $24.00/hr.

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)
  
  
  

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Jun 17, 2025.

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.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  IT Services and IT Consulting

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