Medicare Claims Examiner

TEKsystems; Irvine (CA); Remote; USD 39,000 - 42,000; Full time

Benefits offered by this job

100% Remote

Contract with extension possible

Job summary

TEKsystems is seeking a Medicare Claims Examiner (D-SNP) for a fully remote contract role. California residents only, with hands-on QNXT experience, and a background in Medicare/Medi-Cal claims processing will excel.

Responsibilities include reviewing and adjudicating claims, researching pended/denied D-SNP cases, maintaining CPT/HCPCS/ICD coding documentation, and ensuring CMS compliance. Strong analytical skills and the ability to work independently in a remote, production-driven environment

Qualifications

• 3+ years of Claims Examiner or healthcare claims processing experience.
• Medicare and/or Medi-Cal claims processing experience.
• D-SNP (Dual Eligible Special Needs Plan) experience.
• Health plan experience.
• Strong understanding of claims adjudication and payment determination.
• Experience working in a high-volume production environment.
• Knowledge of CPT, HCPCS, ICD, and HCFA coding.
• Medical terminology knowledge.
• Strong analytical, organizational, and communication skills.
• Ability to work independently in a remote environment.
• Proficiency with Microsoft Office and claims processing systems.

Responsibilities

• Review, research, price, and process paper and electronic claims.
• Research and resolve pended and denied D-SNP claims.
• Determine claim payment eligibility and adjudicate claims.
• Review manual review and audit reports.
• Maintain documentation related to CPT, HCPCS, ICD, and HCFA coding.
• Ensure compliance with Medicare, Medi-Cal, CMS, and health plan guidelines.
• Communicate with internal departments regarding claim issues and resolutions.
• Identify trends and support process improvement efforts.
• Meet productivity, quality, and turnaround-time expectations.

Skills

Medicare claims processing

D-SNP experience

High-volume production

Communication skills

Analytical skills

Remote work capability

Tools

QNXT

MS Office

Job description

Medicare Claims Examiner (D-SNP) | 100% Remote | California Residents Only

Seeking an experienced Medicare Claims Examiner to join their team in a fully remote position. This is an excellent opportunity for candidates with a strong background in Medicare claims processing, D-SNP plans, and health plan operations.

Important: Candidates must reside in California and have hands-on QNXT experience. QNXT is a required qualification and candidates without QNXT experience will not be considered.

Responsibilities

• Review, research, price, and process paper and electronic claims

• Research and resolve pended and denied D-SNP claims

• Determine claim payment eligibility and accurately adjudicate claims

• Review manual review and audit reports

• Maintain documentation related to CPT, HCPCS, ICD, and HCFA coding

• Ensure compliance with Medicare, Medi-Cal, CMS, and health plan guidelines

• Communicate with internal departments regarding claim issues and resolutions

• Identify trends and support process improvement efforts

• Meet productivity, quality, and turnaround-time expectations

Required Qualifications

• 3+ years of Claims Examiner or healthcare claims processing experience

• Medicare and/or Medi-Cal claims processing experience

• D-SNP (Dual Eligible Special Needs Plan) experience

• Health plan experience

• Strong understanding of claims adjudication and payment determination

• Experience working in a high-volume production environment

• Knowledge of CPT, HCPCS, ICD, and HCFA coding

• Medical terminology knowledge

• Strong analytical, organizational, and communication skills

• Ability to work independently in a remote environment

• Proficiency with Microsoft Office and claims processing systems

Must-Have Qualifications

• QNXT experience is required

• Medicare Advantage and/or D-SNP experience is required

• Health plan experience is required

• Must currently reside in California

• Must be comfortable working in a production-driven environment

Additional Information

• 100% Remote

• Equipment provided by CenCal Health

• Contract opportunity with potential for extension based on performance and business needs

Job Type & Location

This is a Contract position based out of Irvine, CA.

Pay and Benefits

The pay range for this position is $28.50 - $30.50/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)

Application Deadline

This position is anticipated to close on Oct 30, 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

Were 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. Were 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. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were 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.