Remote Claims Analyst II – Medical Claims Specialist

TEK Systems; Appleton (AL); Remote; USD 22,000 - 31,000; Full time

Job summary

TEKsystems is seeking a detail-oriented Claims Analyst II to support our healthcare claims team. The role focuses on reviewing, analyzing, and adjudicating medical claims while ensuring compliance with plan benefits, medical policies, and regulatory guidelines.

Ideal candidates will have 2–4 years of medical claims processing experience, knowledge of CPT/ICD coding, and familiarity with QMNT tasks. This remote, contract-to-hire position is based out of Appleton, WI, offering growth in a large

Qualifications

• High school diploma or equivalent.
• 2-4 years of medical claims processing experience.
• Experience adjudicating professional and facility healthcare claims.
• Knowledge of medical terminology, CPT coding, ICD-9/ICD-10 coding, COB and subrogation processes.

Responsibilities

• Review, analyze, and adjudicate professional and facility medical claims in accordance with plan benefits, policies, and procedures.
• Verify claim accuracy, billing compliance, and completeness of submitted documentation.
• Process approved claims and ensure timely, accurate payments.
• Investigate and resolve suspended or pending claims within established turnaround times.
• Identify and process COB, Workers' Compensation, and Subrogation claims appropriately.
• Maintain thorough documentation of claim decisions, adjustments, and payment activities.

Skills

Medical claims processing

Claims adjudication

Healthcare operations

Education

High school diploma

Tools

QNXT Claims Workflow

Job description

TEKsystems is seeking a detail-oriented Claims Analyst II to support our healthcare claims team. The role focuses on reviewing, analyzing, and adjudicating medical claims while ensuring compliance with plan benefits, medical policies, and regulatory guidelines.

Ideal candidates will have 2–4 years of medical claims processing experience, knowledge of CPT/ICD coding, and familiarity with QMNT tasks. This remote, contract-to-hire position is based out of Appleton, WI, offering growth in a large