Remote Medical Claims Analyst II (WI)

TEKsystems; Madison (WI); Remote; USD 22,000 - 31,000; Full time

Benefits offered by this job

Remote work options

Hybrid/onsite flexibility

Comprehensive training program

Stable schedule (Mon-Fri)

Job summary

TEKsystems seeks a detail-oriented Claims Analyst II to review, analyze, and process medical claims in a role that can be remote within Wisconsin, onsite, or hybrid. Candidates must reside in Wisconsin and be able to pick up equipment from Menasha or Brookfield offices.

The role emphasizes accuracy, compliance, and adherence to health plan policies, with a stable Monday-Friday schedule and comprehensive virtual training.

Qualifications

• 2-4 years of medical claims processing experience.
• Knowledge of CPT coding.
• Knowledge of ICD-9 and ICD-10 coding.
• Knowledge of COB (Coordination of Benefits).
• Knowledge of subrogation processes.

Responsibilities

• Process professional and facility medical claims for payment according to plan benefits and policies.
• Review claims for completeness and compliance with billing standards.
• Determine pay/deny/return/pending based on guidelines.
• Investigate and resolve pending claims within timeframes.
• Identify and process COB, workers' compensation, and subrogation claims.
• Monitor claims processing systems and correct errors.
• Process specialty claims (transplant, COB, complex types).
• Review claims for repricing and apply network discounts.
• Document decisions and maintain records.
• Meet department quality and productivity standards; maintain confidentiality.
• Stay updated on benefit plans, provider agreements, and regulations.

Skills

Medical claims processing

CPT coding

ICD-9/10 coding

COB knowledge

Subrogation

Analytical skills

Attention to detail

Independent work

Job description

TEKsystems seeks a detail-oriented Claims Analyst II to review, analyze, and process medical claims in a role that can be remote within Wisconsin, onsite, or hybrid. Candidates must reside in Wisconsin and be able to pick up equipment from Menasha or Brookfield offices.

The role emphasizes accuracy, compliance, and adherence to health plan policies, with a stable Monday-Friday schedule and comprehensive virtual training.