Claims Processor, Entry Level

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $20 - $22 / hour

⏳ Contract/Temporary

⚪️ Entry-level

📋 Claims Specialist

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Review and process medical, dental, vision, electronic, and HIPD claims • Process claims in accordance with state, federal, health plan regulatory requirements, and department guidelines • Meet established quality and production performance benchmarks • Research and review applicable documentation • Thoroughly review, analyze, and research health care claims • Identify discrepancies and verify pricing • Confirm prior authorizations • Process claims for payment • Assist in resolving issues from providers, customer service, member services, health plans, and other internal customers • Examine problems, data, or text and weigh multiple sides and consequences before making decisions • Partner with peers to document and analyze functional requirements, identify gaps, and determine alternative approaches • Contribute to defining and documenting standards and reviewing them against industry standards • Alert supervisors to potential higher-risk compliance issues • Recognize issues, solve problems, research, identify trends, and determine actions needed • Follow up as necessary and involve appropriate people in resolving problems • Report to the Supervisor of Claims

🎯 Requirements

• Recent Medical Billing or Medical Coding Certification • Must live within 60 miles of Fresno, CA • Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for accurate claim adjudication and/or benefit determination • Good verbal and written communication skills • Proficient in 10-key by touch • Data entry/type 40 WPM • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint) • Capability to quickly learn new applications • Ability to work under pressure and adapt to a changing environment • Working knowledge of ERISA claims processing/adjudication guidelines • Ability to ensure compliance with applicable policies, practices, and local, state, and federal regulations and requirements regarding claims and contract administration • Entry-level position

🏖️ Benefits

• 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)