Medicare Claims Processor (Remote To Wisconsin Only)

TEKsystems•Menasha, WI

3d•$19 - $19•Remote

About The Position

We are seeking a Claims Analyst II to examine and process both paper and electronic healthcare claims. In this role, you will determine whether claims should be returned, pended, denied, or paid in accordance with established policies, procedures, and benefit plans. This position plays a critical role in ensuring accurate, timely claim adjudication while maintaining confidentiality and quality standards. Must be able to pick up equipment from either our Menasha or Brookfield office. Fully Remote (Wisconsin Residents Only) Schedule: Full‑time (40 hours/week)

Requirements

2–4 years of healthcare claims processing experience
Knowledge of:
Medical terminology
CPT and ICD‑9/ICD‑10 coding
Coordination of Benefits (COB), subrogation
Ability to manage confidential information with accuracy and professionalism
Strong attention to detail and time‑management skills
Must reside in Wisconsin
Eligible to work:
Fully remote (home office requires reliable internet)
Menasha office
Brookfield office
Hybrid model
Equipment must be picked up in Menasha or Brookfield

Nice To Haves

Medicaid or ACA plan experience
Claims adjudication experience
Coding experience
Prior experience with QNXT™ Claims Workflow

Responsibilities

Adjudicate professional and facility claims in accordance with member Certificates of Coverage, medical policies, and plan benefits.
Review claims for accuracy, proper billing standards, and completeness of information.
Determine appropriate claim disposition (pay, deny, pend, or return) within established timeframes.
Obtain additional or missing information from providers, members, or internal partners as needed.
Maintain department quality standards and required turnaround times.
Identify and process Coordination of Benefits (COB), Workers’ Compensation, and Subrogation claims.
Investigate and resolve pending claims; deny claims when resolution timelines are exceeded.
Monitor claims processing systems for errors and make necessary corrections or adjustments.
Review claims for re‑pricing and apply internal or external provider discounts as appropriate.
Review home office claims for payment up to $18,000.
Process specialty claims (e.g., transplant, URN, COB) according to external contract requirements.
Accurately document claim decisions, attributes, and memos.
Stay current on group contracts, provider discounts, authorizations, and utilization management policies.
Perform additional duties as assigned.