Remote Claims Analyst II: Adjudication & Payments

TEK Systems; Appleton (AL); On-site; USD 26,000 - 29,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan — Pre-tax & RSP

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Employee Assistance Program

PTO / Vacation

Job summary

TEKsystems is seeking a Claims Analyst II for a fully remote contract-to-hire role. You will adjudicate and process professional and facility claims, ensure policy compliance, and maintain quality standards.

You will review eligible claims, gather required information, and manage COB or subrogation issues while adhering to confidentiality and policy guidelines. Experience with CPT/ICD and ACA/Medicaid is preferred.

Qualifications

• High school diploma or equivalent required.
• 2–4 years of claims processing experience required.
• Knowledge of CPT and ICD-9/ICD-10 is preferred.
• Experience with ACA or Medicaid plans is a plus.
• Coding experience is preferred.

Responsibilities

• Process professional and facility claims for payment.
• Review claims for proper billing standards and completeness.
• Obtain information from appropriate parties as needed.
• Maintain department quality standards and turnaround times.
• Identify COB, workers' compensation, and subrogation issues.
• Document attributes and memos for claims payment.
• Process specialty claims to determine pricing per contracts.
• Perform other duties as assigned.

Skills

Adjudication

Claims adjudication

Claims processing

EOB

Customer service

Data entry

Metrics

Education

High school diploma or equivalent

2-4 years claims processing experience

Tools

QNXT Claims Workflow

Job description

TEKsystems is seeking a Claims Analyst II for a fully remote contract-to-hire role. You will adjudicate and process professional and facility claims, ensure policy compliance, and maintain quality standards.

You will review eligible claims, gather required information, and manage COB or subrogation issues while adhering to confidentiality and policy guidelines. Experience with CPT/ICD and ACA/Medicaid is preferred.