Claims Analyst

TEKsystems

. Examine and process paper and electronic claims .

Posted 11/2/2026contractRemote • Wisconsin • United StatesJuniorMid-Level💰 $19 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing, including adjudication, compliance with policies, and coordination of benefits. Proficient in utilizing claims processing systems and maintaining quality standards while resolving claims efficiently.

Highest-signal resume keywords

Medical Claims Processing ExperienceKnowledge Of Current Procedural Terminology (CPT)Knowledge Of International Classification Of Diseases (ICD-9 And ICD-10)Knowledge Of Coordination Of Benefits (COB)Experience With QNXT Claims Workflow

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationClaims ProcessingMedical TerminologySubrogation KnowledgeBilling Standards CompliancePayment ProcessingClaims InvestigationData EntryRepricing ClaimsCoding Experience

Soft Skills

Attention To DetailProblem SolvingCommunication SkillsOrganizational SkillsTime Management

Tools & Technologies

QNXT Claims WorkflowComputerized Claims-Processing SystemsWRAP Network Repricing Website

Industry Keywords

ACAMedicaidHealth PlansProvider DiscountsUtilization Management Policies

About the role

Key responsibilities & impact

Examine and process paper and electronic claims
Determine whether to return, pend, deny, or pay claims according to established policies and procedures
Adjudicate claims 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 for completeness and validity
Process payments for approved claims
Process Professional and Facility claims according to coverage certificates, medical policies, procedures, and plan benefit interpretations
Review claims for billing standards compliance and completeness
Obtain additional information from appropriate persons or agencies
Maintain department quality standards and processing turnaround times
Identify and adjudicate coordination of benefits (COB), Workers Compensation, and Subrogation issues
Investigate and resolve pending claims within established time frames
Monitor computerized claims-processing systems for errors and make corrections or adjustments
Maintain current knowledge of group contracts, provider discounts, percentages, per diems, enrollee certificates, agreements, authorizations, and utilization management policies
Review home office claims for payment up to $18,000.00
Review claims for repricing and enter eligible claim data into the WRAP network repricing website
Override allowed amounts to apply internal or external discounts
Document pertinent claims-payment attributes and memos
Process specialty claims, including transplant, URN, and COB, according to external contract pricing
Perform other assigned duties

Requirements

What you’ll need

High school diploma or equivalent preferred
2-4 years medical claims processing experience required
Knowledge of current procedural terminology (CPT)
Knowledge of international classification of diseases (ICD-9 and ICD-10)
Knowledge of medical terminology
Knowledge of COB processing
Knowledge of subrogation
Past experience using QNXT Claims Workflow a plus
Prior experience with ACA, Medicaid, or similar health plans preferred
Coding experience preferred

Benefits

Comp & perks

Medical, dental & vision
Critical Illness, Accident, and Hospital coverage
401(k) Retirement Plan with pre-tax and Roth post-tax contributions
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)