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Description

Under direct supervision reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.

ESSENTIAL FUNCTIONS:

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.

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.

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.

Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

Qualifications

Education Level: High School Diploma or GED

3+ 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

Details:

100% Remote

Pay: $23.04/hr.

Pay Cycle – weekly | medical, dental & vision benefits offered.

Pay and Benefits

The pay range for this position is $23.04 - $23.04/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 5, 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.