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Claims Processor - Wisconsin Residents Only

TEKsystems
$19.25 / hr
life insurance, sick time, 401(k), retirement plan
United States, Wisconsin, Menasha
Jun 11, 2025
About the Role We are seeking a detail-oriented and experienced Claims Analyst II to join our growing team. In this role, you will be responsible for examining and processing both paper and electronic healthcare claims. You'll play a key part in ensuring accurate adjudication and timely resolution of claims, while maintaining compliance with policies and confidentiality standards. Key Responsibilities * Review and process professional and facility claims in accordance with member coverage and medical policies. * Determine appropriate action on claims: return, pend, deny, or pay. * Ensure claims meet billing standards and are complete. * Investigate and resolve pending claims within established timeframes. * Identify and adjudicate claims involving COB, Workers Compensation, and Subrogation. * Maintain departmental quality and turnaround standards. * Review claims for re-pricing and apply internal/external discounts. * Process specialty claims (e.g., transplant, COB, URN) and document all relevant claim information. * Stay current on group contracts, provider discounts, and utilization policies. * Perform other duties as assigned. Schedule: Monday-Friday \| 8:00 AM-4:30 PM or 8:30 AM-5:00 PM Employment Type: Full-Time Department: Claims Processing Required Qualifications * High school diploma or equivalent (preferred). * 1.5+ years of healthcare claims processing experience. * Strong knowledge of CPT, ICD-9/10, and medical terminology, Medicaid and/or Medicare * Experience with COB processing and subrogation. * High attention to detail and ability to work independently in a remote setting. Why Join Us? * Remote Flexibility: Work from the comfort of your home with a consistent weekday schedule. * Growth Opportunity: Be part of our expansion as we prepare to launch a Medicaid line of business in January 2026. * Impactful Work: Help ensure accurate and timely healthcare claim processing that directly affects patient care and provider satisfaction. Ready to bring your claims expertise to a mission-driven team? Apply now and help us deliver exceptional service to our members and providers. 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 Jun 13, 2025. 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.