Remote Claims Analyst II - Medical Claims

TEKsystems; United States; Remote; USD 22,000 - 31,000; Full time

Job summary

TEKsystems is seeking a Claims Analyst II to examine and process paper and electronic claims. You will adjudicate by policy, process payments for approved claims, and resolve issues with COB, subrogation, and plan benefits.

This is a Contract to Hire role based in Milwaukee, WI, with fully remote work options. Required are 2–4 years of medical claims processing experience, CPT/ICD familiarity, and knowledge of QNXT workflows.

Qualifications

• High school diploma or equivalent preferred.
• 2-4 years medical claims processing experience required.
• Knowledge of CPT and ICD-9/ICD-10 coding.
• Knowledge of COB processing and subrogation.
• Experience with QNXT Claims Workflow is a plus.

Responsibilities

• Adjudicate claims by following departmental policies, operating memos, and corporate guidelines.
• Process payments for claims that are approved.
• Review claims for completeness and proper billing and policies.
• Identify COB, workers' compensation, and subrogation issues and adjudicate accordingly.
• Maintain department quality standards and turnaround times.
• Enter and adjust claim data as needed and monitor system for errors.
• Investigate pending claims and pend/suspend as required.

Skills

Medical Claims

claims adjudication

Medical Claims Processing

QNXT

COB processing

Education

High school diploma or equivalent

2-4 years medical claims processing experience

CPT/ICD knowledge

ACA/Medicaid experience

Coding experience

Job description

TEKsystems is seeking a Claims Analyst II to examine and process paper and electronic claims. You will adjudicate by policy, process payments for approved claims, and resolve issues with COB, subrogation, and plan benefits.

This is a Contract to Hire role based in Milwaukee, WI, with fully remote work options. Required are 2–4 years of medical claims processing experience, CPT/ICD familiarity, and knowledge of QNXT workflows.