Claims Processor (Wisconsin Only)

TEKsystems•Waukesha, WI

9d•$19 - $19•Remote

About The Position

The Claims Processor (also identified as a Claims Analyst) reviews, analyzes, and adjudicates medical claims while ensuring compliance with benefit plans, medical policies, and processing guidelines. The role handles paper and electronic professional and facility claims, specialty claims, and claims requiring coordination of benefits, workers’ compensation, or subrogation processing. It also involves verifying coding, billing, documentation, pricing, and reimbursement details; resolving pending claims; maintaining accurate claim notes; and meeting production, quality, and accuracy standards. This is a contract-to-hire, full-time role paying $19.25 per hour. The schedule is Monday through Friday, 40 hours per week. The first six weeks include virtual training from 8:00 AM to 4:30 PM. The position is fully remote for candidates residing in Wisconsin, with the option described in the posting to work remotely, onsite, or in a hybrid capacity. Candidates must have reliable internet and be able to pick up company equipment from the Menasha or Brookfield office.

Requirements

2–4 years of medical claims processing experience.
Experience adjudicating professional and facility medical claims.
Knowledge of CPT, ICD-9, and ICD-10 coding.
Familiarity with medical terminology and healthcare claims processes.
Experience with Coordination of Benefits (COB) and subrogation.
Strong analytical and problem-solving skills.
Excellent attention to detail and accuracy.
Ability to meet productivity and quality metrics in a high-volume environment.
Strong written and verbal communication skills.
Must reside in Wisconsin and be able to pick up company equipment from the Menasha or Brookfield office.
Reliable internet access.

Nice To Haves

Experience with QNXT Claims Workflow.
Experience supporting ACA, Medicaid, or other health plan environments.
Medical coding experience.
Experience with claims repricing and network reimbursement methodologies.
Knowledge of provider contracts, benefit plans, and utilization management processes.

Responsibilities

Review and adjudicate paper and electronic medical claims.
Determine whether claims should be approved, denied, pended, suspended, or returned for additional information.
Process professional and facility claims according to benefit plans and medical policies.
Verify claim accuracy, coding, billing standards, and documentation completeness.
Investigate and resolve pending claims within established turnaround times.
Identify and process Coordination of Benefits (COB), Workers' Compensation, and subrogation-related claims.
Monitor claims processing systems for errors and make necessary corrections.
Apply provider discounts, pricing adjustments, and contract-specific reimbursement methodologies.
Process specialty claims, including transplant and COB claims.
Maintain accurate documentation and claim notes.
Meet established productivity, quality, and accuracy standards.
Collaborate with internal teams to resolve claim issues and support operational goals.