Claims Analyst

🔥 48 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $19 / hour

⏳ Contract/Temporary

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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TEKsystems

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1983

💼 Consulting

🎯 Recruiter

🏢 Enterprise

Consulting • Recruitment • Enterprise

TEKsystems is a global IT and business services firm that provides technology consulting, talent solutions, managed services and workforce recruitment to enterprise clients. The company delivers cloud, digital and data services (including AI/ML and automation), application innovation, Agile/DevOps transformation, technology operations and digital experience work, and operates large-scale talent and managed service programs. TEKsystems works across industries (financial services, healthcare, public sector, telecommunications, retail/manufacturing, energy and more), maintains technology partnerships with major cloud and software providers, and reports more than $7B in annual revenue and 100+ locations worldwide.

📋 Description

• 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

• 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

• 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)

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