Remote Healthcare Claims Analyst II Detail-Oriented

TEKsystems; Appleton (WI); À distance; USD 22 000 - 31 000; Plein temps

Résumé du poste

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

You will work on professional and facility claims, verify documentation, and process payments. This remote position offers contract-to-hire potential and opportunities to grow in healthcare insurance operations.

Qualifications

• 2–4 years of medical claims processing experience.
• Experience adjudicating professional and facility healthcare claims.
• Strong understanding of medical claims workflows and payment methodologies.
• Ability to interpret member certificates of coverage, plan documents, and medical policies.

Responsabilités

• Review, analyze, and adjudicate professional and facility medical claims.
• Determine appropriate claim disposition (payment, denial, pend, or return).
• Verify claim accuracy and billing compliance.
• Process approved claims and ensure timely payments.
• Investigate and resolve suspended or pending claims within turnaround times.
• Identify and process COB, workers' compensation, and subrogation claims.
• Maintain documentation of claim decisions and payment activities.
• Review home office claims up to $18,000 for payment approval.

Connaissances

Medical claims processing

Claims adjudication

Analytical skills

Organizational skills

COB knowledge

Formation

High school diploma or equivalent

Outils

QNXT Claims Workflow

Description du poste

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

You will work on professional and facility claims, verify documentation, and process payments. This remote position offers contract-to-hire potential and opportunities to grow in healthcare insurance operations.