Medical Claims Specialist

TEKsystems • Brookfield, WI • 4h ago

Description

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following:

Adjudicate claims by following departmental policies, operating memos, and corporate guidelines.

Resolve claims and related issues in compliance with policy provisions.

Compare claims applications and provider statements with policy files and other records to ensure completeness and validity.

Process payments for claims that are approved.

Job Responsibilities:

Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality.

Reviews claims to ensure compliance with proper billing standards and completeness of information.

Obtains additional information from appropriate person and/or agency as needed.

Identifies potential coordination of benefits (COB), Workers Compensation, and Subrogation issues and adjudicates claims accordingly.

Investigates and resolves pending claims in accordance with established time frames. Identifies claims needing to be pended or suspended.

Reviews pending claims timely and denies claims after established time frame is reached without resolution.

Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed.

Reviews home office claims for payment up to $18,000.00.

Reviews claims for re-pricing. Enters eligible claim data into appropriate WRAP network re-pricing website. Overrides claims allowed amounts to apply internal/external discounts.

Skills

Claims Analyst, Claims Specialist, Claims Adjuster, Medicaid, claims adjudication, Call Center, Coding

Qualifications

High school diploma or equivalent preferred.

2-4 years claims processing experience required

Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation.

Past experience using QNXT Claims Workflow a plus

Prior experience with ACA, Medicaid, or similar health plans preferred.

Coding experience preferred.

Job Type & Location

This is a Contract to Hire position based out of Brookfield, WI.

Pay and Benefits

The pay range for this position is $19.25 - $19.25/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Mar 31, 2026.

h4>About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

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