Healthcare Claims Specialist

TEKsystems • Madison, WI

7d • $19 - $19 • Remote

About The Position

The Claims Analyst II reviews, analyzes, and processes professional and facility medical claims, ensuring accuracy, compliance, and adherence to health plan policies and procedures. The role includes determining claim outcomes, investigating pending claims, handling complex claim types, and maintaining accurate documentation while meeting quality and productivity standards.

This contract-to-hire position is based in Madison, Wisconsin. The posting describes the role as fully remote, with remote work limited to Wisconsin residents. Candidates must be able to pick up company equipment from the Menasha or Brookfield office. Training is provided virtually for the first six weeks, from 8:00 AM to 4:30 PM. After training, employees may discuss scheduling flexibility with their supervisor; standard operating hours are 8:00 AM to 5:00 PM, Monday through Friday.

Requirements

• 2–4 years of medical claims processing experience.
• Knowledge of CPT coding.
• Knowledge of ICD-9 and ICD-10 coding.
• Knowledge of medical terminology.
• Knowledge of Coordination of Benefits (COB).
• Knowledge of subrogation processes.
• Strong analytical, organizational, and problem-solving skills.
• Ability to work independently while maintaining accuracy and productivity.
• High attention to detail and commitment to quality.
• Must reside in Wisconsin.
• Must be able to pick up company equipment from the Menasha or Brookfield office.

Responsibilities

• Process professional and facility medical claims for payment according to plan benefits, medical policies, and coverage guidelines.
• Review claims for completeness, accuracy, and compliance with billing standards.
• Determine whether claims should be paid, denied, returned, or pended based on established guidelines.
• Investigate and resolve pending claims within established timeframes.
• Identify and process Coordination of Benefits (COB), Workers’ Compensation, and subrogation claims.
• Monitor claims processing systems and correct errors or discrepancies as needed.
• Process specialty claims, including transplant, COB, and other complex claim types.
• Review claims for repricing and apply appropriate network discounts.
• Document claim decisions and maintain accurate records.
• Meet department quality and productivity standards while maintaining confidentiality.
• Stay current on benefit plans, provider agreements, medical policies, and claims processing regulations.

Benefits

• Medical, dental, and vision benefits, if eligible.
• Critical illness, accident, and hospital coverage, if eligible.
• 401(k) retirement plan with pre-tax and Roth post-tax contributions available, if eligible.
• Voluntary life and AD&D insurance for employees and dependents, if eligible.
• Short- and long-term disability coverage, if eligible.
• Health Spending Account (HSA), if eligible.
• Transportation benefits, if eligible.
• Employee Assistance Program, if eligible.
• Time off or leave, such as PTO, vacation, or sick leave, if eligible.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed