New

Medical Claims Analyst

TEKsystems
$19.25 / hr
life insurance, sick time, 401(k), retirement plan
United States, Wisconsin, Madison
May 28, 2025
This position is remote to Wisconsin residents only! Description As a Claims Analyst II you will be tasked with the following: - Examine and process paper claims and/or electronic claims. - The person in this role determines whether to return, pend, deny or pay claims within established policies and procedures. - Determines steps necessary for adjudication. - Follows established departmental policies and procedures, operating memos and corporate policies to resolve claim and claim issues. - Settles claims with Claimants in accordance with policy provisions. - Compares claims application and/or provider statement with policy file and other records to evaluate completeness and validity of claim. - Pays claimant's amount due. Additional Duties: - 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. - Maintains department quality standards. - Maintains established department turn-around processing time. Maintain and/or improves individual production rate standards and department quality s-standards. - 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. - Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc. - 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. - Appropriately documents attributes and memos for pertinent information related to claims payment. - Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract. - Performs other duties and responsibilities as assigned. Qualifications - High school diploma or equivalent preferred. - 1.5-4 years claims processing experience required (healthcare related) - Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation. PLUS: - Coding experience preferred. - Past experience using QNXT Claims Workflow a plus Hours Remote M-F, 40 hours per week 8am-4:30pm or 8:30pm-5pm 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 6, 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.