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Description

FULL TIME REMOTE PURPOSE: Under direct supervision reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures. ESSENTIAL FUNCTIONS: 60 Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy contracts policies and procedures allowing timely considerations to be generated using multiple systems. 25 Completes research of procedures. Applies training materials correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions. 10 Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling quality improvement initiatives workflow design and financial planning etc. 5 Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions. Qualifications To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education Level: High School Diploma or GED Experience: more than three years experience processing claim documents. Experience with processing Inter-Plan Teleprocessing System ITS Claims. Preferred Qualifications 5 years Claims processing billing or medical terminology experience Knowledge Skills and Abilities KSAs Demonstrated analytical skills Proficient Demonstrated reading comprehension and ability to follow directions provided Proficient Basic written/oral communication skills Proficient Demonstrated ability to navigate computer applications Proficient The incumbent is required to immediately disclose any debarment exclusion or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities deadlines and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer including customers who may be demanding or otherwise challenging.

Additional Skills & Qualifications

From Spotlight Call: Claims adjudication, processing or denying claims according to benefits Plus to have Luminex and Blue Squared Plus of medical billing/terminology MS Excel, Outlook CMS or Medicare reimbursement would be a plus 5 yrs of claims processing ideally 200-300 claims processed daily - this is a must have, ask candidates Training 3-5 weeks Procedural 98%+ and financial 99%+ required Training is 3-5 weeks, 8:30am-5pm EST, training is 9:30am-4:30pm so will have some independent time. Once they are associates they will have flexibility, can start as early as 7am. Learning the system (luminex) then also learning Blue Squared, it is like a communication system where claims are submitted, it gives details from the other Blues plans.

Experience Level

Entry Level

Pay and Benefits

The pay range for this position is $23.16 - $23.16/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 May 31, 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.